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Retreat Packages
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Guest Registration and Consent Form

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Personal Information

Please tell us a little about yourelf.

Name *

First

Middle

Last

Age

Email *

Gender *

Preferred Pronouns

Phone Number *

Home Country *

Passport Number

Best Form of Contact *

Phone
WhatsApp
Email

Arrival & Stay Details

Your travel dates and accommodation details.

Expected Date of Arrival

Check in date

Expected Date of Departure.
Check out date

Please Enter Discount Code
Check our website for available special offers or discount codes.

Retreat Package Selection

Choose your retreat program and room preference.

Retreat Package
One Day Wellness Retreat
Yoga, Meditation Hiking and Sound Healing Retreat (1-30 Days)
Group Yoga Retreat
Sound Healing Teacher Training (TTC)
5 Day Sound Healing & Meditation Certificate Course
10 Day Prana Shakti Certificate Course
Online TTC Classes
Drop in Yoga Classes

Accomodation Type:
Single Room
Double (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 Search
Facebook
Instragram
Other Social Network

What do you hope to gain from this retreat (Goals)?

Health & Experience

This helps us guide you safely during yoga and hiking.

Yoga Experience:
First time doing yoga
Beginner
Intermediate
Advanced
Yoga Teacher

Hiking 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?
Yes
No

If "Yes" please let us know below:

Do you have any allergies or dietary restrictions?
Yes
No

If "Yes" please let us know below:

Consent & Agreement

Please 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 & Submit

Type 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.

© Copyright - Niru Yoga Home Stay | Yoga Retreats in Nepal

Registered Homestay – Govt. of Nepal, Dept. of Tourism (No. 234/2016 & 07/080/081/2024)