India Retreat 2024 Sign Up Form First Name *Last Name *Email Address *Phone *Emergency contact name and number *Please tell us why you are interested in joining us on this retreat *Check if you do not want to be added to the CCY newsletterNo thanksLeave unchecked to be the first to know about our upcoming offerings. We send no more than one email a week, usually less.Payment OptionsPlease send your deposit through one of these methods. If you plan to use check or cash, please message us to set that up.Deposit/Payment Method *Cash/CheckVenmoPaypalZelleCashappHave you sent your deposit with this form? *I have sent $250 to reserve my spot and will pay the rest of the deposit by June 30I have sent my $500 deposit to reserve my spotThe deposit is $500; however $250 will hold your space with registration and we will need the other $250 by June 30. Deposit is refundable until June 30.How would you like to pay the remaining balance? *I will pay in full nowI will pay in full by September 30, 2024 (installments or pay in full)The full cost be paid in full by September 30, 2024Liability ReleaseI agree to the following Liability Release • I agree to pay the deposit ($250 or the full $500) with the submission of this form and to complete payment of the deposit by June 30, 2024. Refunds of any amount paid, except the deposit, are available until July 31, 2024. All retreat costs must be paid by September 30, 2024. • I understand that I am solely responsible for my health and safety, and will not hold retreat leaders responsible, nor the hosting facility, for any loss, injuries, or illness that may occur. • I understand that I must be mindful of my own limitations with respect to yoga and meditation • I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any activity program. I represent and warrant that I am physically fit and I have no medical condition that would prevent my participation in yoga or workshops. • I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every class. CommentsUse this space to list anything you would like us to know including if someone you know is registering and you want to room with themSubmit
