Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Personal InformationPlease tell us a little about yourelf.Name *FirstMiddleLastAgeEmail *Gender *FemaleMaleTransgender FemaleTransgender MaleNon BinaryPrefer no to answerPreferred PronounsIf anyShe/HerHe/HimThey/ThemPhone Number *Home Country *Passport NumberBest Form of Contact *PhoneWhatsAppEmailArrival & Stay DetailsYour travel dates and accommodation details.Expected Date of Arrival *Check in dateExpected Date of Departure. *Check out datePlease Enter Discount Code If availableRetreat Package SelectionChoose your retreat program and room preference.Retreat Package *One Day Wellness RetreatYoga, Meditation Hiking and Sound Healing Retreat (1-30 Days)Group Yoga RetreatSound Healing Teacher Training (TTC)5 Day Sound Healing & Meditation Certificate Course10 Day Prana Shakti Certificate CourseOnline TTC ClassesDrop in Yoga ClassesAccomodation Type: *Single RoomDouble (with friend)Double **Please note if double room is chosen you may be assigned a roommate during your stay.Roommate's Name (If coming with someone else):Additional Night(s) – Shared Room ($60/night)Note: Additional shared room nights are $60 each. Inform us if you wish to extend your stay.Additional Night(s) – Single Room ($100/night)Note: Additional single room nights are $110 each. Inform us if you wish to extend your stay.How did you learn about us? *Previous Guest(s)Google SearchFacebookInstragramOther Social NetworkWhat do you hope to gain from this retreat (Goals)?Health & ExperienceThis helps us guide you safely during yoga and hiking.Yoga Experience: *First time doing yogaBeginnerIntermediateAdvancedYoga TeacherHiking Experience *Beginner (short flat hikes)Intermediate (able to walk 3-6 miles in various terrain)Expert (long treks at higher altitude)Which style(s)or tradition(s) of yoga have you practiced?Do you have any chronic health conditions or injuries that may impact your ability to practice yoga or hiking? *YesNoIf "Yes" please let us know below:Do you have any allergies or dietary restrictions? *YesNoIf "Yes" please let us know below:Consent & AgreementPlease read and agree before submitting the form.Participant Consent:I understand and accept my personal responsibility during yoga and hiking.This includes informing the instructor of any injury or health condition, following instructions, stopping activities if I feel unwell, and accepting responsibility for my own safety.I understand that photos or videos are taken only with my permission.I agree to the booking and payment terms.I understand and confirm that I have signed this Agreement freely, voluntarily, under no duress. My signature below is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability toward Niru Yoga Homestay, Yoga Pathshala or any affiliates to the full extent of the law.Signature & SubmitType your full name as your digital signature.By providing my signature below, I confirm I have read and understood the statements below and the information provided above is true and correct to the best of my knowledge. *Please enter your full name as your form of signature.Submit
