Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstMiddleLastAgeEmail *Gender *FemaleMaleTransgender FemaleTransgender MaleNon BinaryPrefer no to answerPreferred PronounsIf anyShe/HerHe/HimThey/ThemPhone Number *Home Country *Passport Number *Best Form of Contact *PhoneWhatsAppEmailExpected Date of Arrival * Check in date At Niru Yoga Homestay, guests have the flexibility to stay for durations ranging from just one day to an entire month.Expected Date of Departure. *Check out dateRetreat Package *One Day Wellness RetreatYoga and Hiking Retreat5 Day Sound Healing & Meditation Retreat10 Day Healing/Detox Retreat4 Day Sound Healing Course10 Day Prana Shakti Certificate CourseGroup Yoga Retreat10 Day Ayurvedic Detox RetreatOnline TTC ClassesAt Niru Yoga Homestay, guests have the flexibility to stay for durations ranging from just one day to an entire month, depending on their preferences and needs.Accomodation 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)?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:Participant Consent: *I understand that I must be mindful of my own limitations with respect to yoga and meditation.I acknowledge it is my responsibility to inform the instructor when I begin a class or hiking of any injury or othercondition that might affect my ability to participate and to inform the instructor immediately if any injury occurs during class.If at any time I feel that instructions or class/hiking activities present any risk of injury to me, or if I feel tired or otherwise unable to perform class activities I will inform the instructor and refrain from activities in question.I understand that I must pay for the full cost of my stay before or upon arrival to Niru Yoga Homestay.I grant Niru Yoga Homestay/Yoga Pathshala the right to take photographs of me during my stay and I authorize Niru Yoga Homestay/Yoga Pathshala to copyright, use and publish the same in print and/or electronically. I agree that Niru Yoga Homestay/Yoga Pathshala may use such photographs of me with for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. (Please noteL: we completely respect your privacy if you choose not to participate in this clause)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.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
