Application Form Retreat

Vikasa Retreat Application Form

Evolve / Silent / Escape Retreat / Balance / Refresh / Yin / Thrive / Move

Name*
First Last
Email*
Enter Email Confirm Email
Birthday*
DD slash MM slash YYYY
Which course would you like to attend?*
Room for May/Jun 2023 Advanced Course
Room for May/Jun 2024 Advanced Course
Room for Nov/Dec 2023 Advanced Course
Part 1 & 2:
Parts 1 and 2 are offered as a package. We do not offer Part 1 or Part 2 on their own.
Room for Jan/Feb 2023 Foundation Course
Room for August 2023 Refresher Course
Room for April 2023 Foundation Course
Room for July 2023 Foundation Course
Room for October 2023 Foundation Course
Room for October 2022 Foundation Course
Room for Nov 2023 Retreat
Rooms for Balance Retreat
Rooms for Move Retreat
Rooms for Thrive Retreat
Rooms for Refresh Retreat
Rooms for Evolve Retreat
Rooms for Balance Retreat
Rooms for Silent Retreat
Rooms for Escape Retreat
Rooms Availability & Exams
*All rooms for all courses are subject to availability.
*Please keep in mind that the $500 USD deposit will secures your room, otherwise we cannot guarantee you’ll have the room you choose available.
*After submitting your form, please wait for confirmation from our team to ensure we have availability.
Universal Yoga Note:
*Prices include $100 USD per part for exam and certificate. If students do not wish to take the exam or get a certificate, their price is $100 USD less per part
*Prior graduates are eligible for a 25% discount for the tuition component of their invoice
Promo Code
Promo Code Retreat
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Price:
Total
$0.00
Personal details
What's your nationality?*
What languages do you speak?*
What is your current occupation?*
What is your yoga history?*
Please provide details of any previous Retreat you have completed and your yoga experience (if applicable)
Do you have any injuries or medical conditions that may that may affect your yoga practice?*
How did you find out about the course? (can select more than one)*
- Facebook
- Instagram
- Google Search
- Friend / Graduate
- Other
If other, please describe:*
Insert referral code from affiliate here if applicable:

Affiliate Program - Get $100 extra Discount
What was the primary reason for choosing this Retreat?*
Comments
Terms and conditions. Please check all of the checkboxes. By submitting this form you agree to all of the following conditions:
Due to limited spaces for Vikasa Retreat throughout the year a deposit is required to secure the booking. A non-refundable $500 deposit is payable at the time of booking with the remaining balance due no later than 45 days prior to start of the course.
*
- I understand that this retreat will be both physically and mentally challenging, with two yoga practices daily along with up to 6 hours of required class and workshop time. I am also aware that yoga is a physical practice and I take full responsibility for any injuries or accidents that may occur during the retreat as a result of my doing. I take full responsibility for my own health and well-being during the course and will not hold Vikasa Yoga or any of the teaching staff responsible for injuries or other medical problems that might occur.
*
- I understand that a positive, team-oriented, optimistic attitude is a requirement for all attendees. Disruptive, rude, or negative behaviour will not be tolerated and may result in removal from the course. I understand that cigarettes, alcohol, and illegal drugs will NOT be permitted for the duration of the training.
*
- I understand that group meals cannot be custom ordered to fit personal needs or requirements simply because personal dietary preferences and needs vary so greatly. If I have specific nutritional needs, I understand I need to make arrangements myself
*
- I understand that the course deposit of 500 USD is non-refundable and that remaining tuition paid is 100% refundable up until 45 days before course start date, after which time, it becomes non-refundable as well.

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Application Form Retreat

Vikasa Retreat Application Form

Personal details

Terms and conditions. Please check all of the checkboxes. By submitting this form you agree to all of the following conditions:

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