Ayurveda and Yoga Registration
Please complete a registration form for each person.
All fields with * must be filled out in order for this form to be submitted to us.
 

2. Personal Information:
* Full Name:             Gender:    
* E-Mail:      
Phone (Day):      
Full Address:      
 
3. Emergency Contact Information:
Contact Name / Relationship:      
Contact Phone:      
Contact E-Mail:      
 

4. How did you hear about us? *  (please specify)  

 
5. We offer a lacto-vegetarian yogic diet. While we do our best to provide options for various diets, we cannot guarantee this. Please list any dietary restrictions:  
 

6. Please indicate your levels of yoga: *              
  (comment as needed)   

 

7. Please list any pre-existing health conditions:   (ie. high blood pressure, active asthma and pregnancy stage), active injuries and prescribed medications that you will be taking at the time of the program.

 

8. Retreat Fees:* Fees listed below include cost of tuition and accommodation (all facility usage, vegetarian meals, tea bar, and evening programs). While every effort will be made to provide your first choice for accommodation, on-site options fill up fast, so if you are willing to consider other accommodation choices, please select "2nd Choice" and "3rd Choice" options.

           Fee Amount = Accommodation + Tuition Wait-list if not available?
First Choice:   No     Yes
Second Choice:   No     Yes
Third Choice:   No     Yes

9. Would you like to come early or stay longer? Yes, I would like to stay for extra nights.   No thank you.

10. Special Discount:   For those staying in-house in shared accommodations, bring a friend for a $50 reduction each!   Commuters who bring a friend each receive a $25 reduction.
    Friend's Name:    

 

11. Bodywork treatments: Interested in receiving a treatment at our on-site Ayurveda wellness centre? We recommend booking at least two weeks in advance to ensure the best availability. For more information or to book an appointment, contact us 250.537.8443 or chikitsashala@saltspringcentre.com.

12. PAYMENT METHOD:     PayPal    Credit Card (By Phone)    Personal Cheque / Money Order

All fees must be paid in full to hold your reservation. Rates are quoted in Canadian dollars and include all applicable taxes.

If you select PayPal as your payment method, a PayPal invoice will be emailed to you. If you wish to phone in your credit card information, please call us at 250.537.2326. Your credit card number will not be kept in our files subsequent to processing your payment. Please do not under any circumstances send your credit card information by e-mail. We also take Canadian or US cheques and/or money orders. Payments in US funds will be credited toward program fees at the prevailing exchange rate.

13. CANCELLATION POLICY: *     I have read the Salt Spring Centre's Cancellation Policy and agree to its terms.  

   


 

The Salt Spring Centre of Yoga
355 Blackburn Rd., Salt Spring Island, BC, Canada V8K 2B8 Phone: 250.537.2326   Fax: 250.537.2311 
Email: yoga@saltspringcentre.com