Cell Phone #:
Emergency Contact (Name & Number):
Name of Roommate:
1. Please describe your yoga experience (No experience is ok :)
2. Do you have any injuries, old or new? Please explain. Recent injuries will require a doctor’s note of approval.
3. What would you like to get out of this retreat?
4. Are there any specific areas of your body that you would like to work on improving strength or flexibility?
5. Are there any specific asanas (yoga postires) that you would like to go over?
6. Our lodging is "dorm style" You will be sharing a room with other retreat guest (max 4 per room). Some of these beds are bunkbeds. Would you prefer top or bottom bunk? Requests will be granted first come first serve basis.
7. Are you physically able to get into a top bunk? Is there a reason you would NEED a bottom bunk? (strength, flexiability, injury or fear) Please explain:
8. Do you have any allergies, sensitivities or special diet?
9. What size T Shirt do you wear?
8. How did you hear about Namaste Yoga Retreats?
Cancel 60+ days prior to start of retreat 100% Refund, minus your non refundable deposit
Cancel 30-60 days prior to start of retreat. Refund is 50% of the total retreat cost, minus your non refundable deposit
Cancel 30 days or less prior to start of retreat No Refund
I understand that if my roommate cancels I have the option of cancelling according to the terms listed above or paying the single rate for the room I have booked. Please sign and date that you have read and understand the cancellation policy
Space is limited. To reserve your spot today, please send your registration form and check to:
402 Moraine Street
Marshfield, MA 02050
Please make checks payable to "Tricia Glynn"
Paypal is accepted. However, please note that an additional charge of 5% will be added to each paypal transaction.
Please contact me if you have any questions.