Inner Healing Immersion: Private Spiritual Retreat

First Name *
Last Name *
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Address *
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Email newsletter	Please send me the email newsletter
Comments or Special Needs
Emergency Contact *	Please provide the name and phone number of the person we should contact in case of emergency.
Are there any medical or health concerns that AYI should be aware of *	Is there anything that would limit your participation in a way that could place you or others at risk during this program? This may include physical limitations, injuries, relevant surgeries, past or present mental health conditions, PTSD, substance use history, medications, or any other factor we should be aware of for your safety and support. Please write “none” if you have no known concerns.
Terms and Conditions *	I understand and accept the Responsibility & Liability Agreement and the Protected Materials AgreementPlease read the Responsibility & Liability Agreement and the Protected Materials Agreement here
Cancellation Policy *	I understand and accept the following registration policyIn addition to our standard Cancellation policy (more strict requirements apply) • $500 non-refundable deposit due at the time of registration. Full payment due within 30 days of the program. •Payment plans allowed. Payment plans must be paid in full 30 days in advance of program.
Registration & Cancellation Policy *	I accept the Registration & Cancellation Policy30 Days Notice Please read the Registration and Cancellation Policy
I AM Yoga Therapy may include the use of appropriate touch to improve range of motion, alignment, and body awareness. Please choose one of the following: *	I give Consent for my yoga consultant to use hands-on contact to assist my yoga therapy session. I agree to communicate with my yoga consultant about any particular techniques involving touch that I would prefer to drop or discontinue. I understand that I can inform the yoga consultant of my change in preference in this or future sessions, and that this change in preference will be documented. I prefer a touch-free yoga therapy session. If the yoga consultant absolutely feels they must engage touch for safety in the pose, I understand they will ask permission to assist first. I understand that I can inform the yoga consultant of any change in preference in this or future sessions, and that this change in preference will be documented.
Arrival Time *	If you are NOT able to arrive at the designated registration/check-in time from 4 PM to 6 PM, then it will be self check in.
Exact Arrival Time *	Let us know your exact planned arrival time. If we can't honor your requested time we will contact you to schedule a different time.
Gurudev's Attendence *	At this time, we plan to have Gurudev present for this program. Due to circumstances unforeseen, we cannot guarantee his presence. The cancellation policy remains the same whether he is present or not. Check box to acknowledge that you understand and accept

Guest 1		First Name* Last Name* Gender* Email*
Guest 1		First Name* Last Name* Gender* Email*

Inner Healing Immersion: Private Spiritual Retreat

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