ROOT TO RISE RETREAT

Booking Form

We are so excited that you would like to join us for the Root to Rise Retreat November 16-22. Please complete the form below to begin the registration process. Once we receive your form we will contact you to confirm your booking.

Full Name *

Email *

Phone Number (with Country Code)

Home Country *

Gender *

Preferred Pronouns

Date of Birth (MM/DD/YYYY)

Passport Number

Best Form of Contact *

Phone
WhatsApp
Email

Retreat Package Option *

Shared Dorm Twin Bed (2-4 guests per room, ensuite bathroom, this option is for a twin bed) $2300/person
Shared Dorm King Bed (2-4 guests per room, ensuite bathroom, this option is for a king bed) $2600/person
Private Room Single (one guest, 1 king bed and private ensuite bath) $3000/person
Private Room Double (two guests, 1 king bed and private ensuite bath) $2300/person

*Please note: You will be assigned other retreat guests to the shared dorm rooms. If you are coming with a friend, please add their name below so we can be sure to assign you to the same room.

Roommate's Name (If coming with a friend):

Additional Night(s) if you with to extend your stay - ($120/night)

Please Note: This is the cost for the room and breakfast only.

How did you learn about the Root to Rise Retreat? *

Previous Guest(s)
Google Search
Facebook
Instragram
Other Social Network

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

Yoga Experience: *

First time doing yoga
Beginner
Intermediate
Advanced
Yoga Teacher

Which style(s)or tradition(s) of yoga have you practiced?

Hiking/Trekking Experience *

Beginner (short flat hikes)
Intermediate (able to walk 3-6 miles in various terrain)
Expert (long treks at higher altitude)

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 list them in detail below:

Payment Requirement Acknowledgement: *

I understand that I must pay a deposit equal to 50% of the total retreat cost to guarantee my spot in the Root to Rise Retreat. (I you cancel by October 1, 2025 you will receive a refund of your deposit equal to the total amount minus any money transaction or bank fees)
I understand that I must pay the remaining balance equal to 50% of the retreat cost by October 1, 2025 in order to confirm my booking.

Participant Consent:

I understand that I must be mindful of my own limitations with respect to yoga and meditation.
I understand that I am fully responsible for notifying the retreat organizers in advance of any food allergies, other allergies, chronic health conditions, injuries or any other limitations
I acknowledge it is my responsibility to inform the instructor when I begin a class or hiking of any injury or other condition 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 grant Niru Yoga Homestay, Yoga Pathshala, or Move Your Mind, LLC 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 note: 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.