Wildlife & Yoga Registration Form
Please complete this form to reserve your spot on our Kenyan Highlands Wildlife & Yoga Retreat.
Name
*
First Name
Middle Name
Last Name
E-mail
*
example@example.com
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*
-
Area Code
Phone Number
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*
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Gender
*
Please Select
Male
Female
N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload a copy of your Passport
*
Browse Files
Drag and drop files here
Choose a file
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Which retreat would you like to book?
*
Please Select
25th - 31st October 2024 (One Room Left)
8th - 14th March 2025
11th 17th October 2025
Booking Type
*
Please Select
Private Room per person
Shared Room with a friend: per person
Shared Room with another guest: per person
Please let us know if you are booking with another person you would like to share a room with.
If you would like us to contact them please share their email address.
Emergency Contact
Please let us know the details of who we should contact in case of an emergency.
Name
*
First Name
Last Name
Relationship with Emergency Contact
*
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Dietary Requirements & Allergies
Dietary Requirements
Vegetarian
Pesictarian
Vegan
Other
Do you have any serious allergies (e.g. bee stings, penicillin, nut allergies, etc.)?
If yes, please specify and explain how we should best respond in the event of a medical emergency*
To ensure your safety while on this retreat, medical information is requested. Answers will be held confidential by the staff. What current or past medical or physical conditions are important for us to know about?:*
Yoga Experience
On our retreats, we welcome everyone from complete beginners to experienced yoga practitioners. Please tell us a little more about your Yoga practice.
Please describe your yoga experience.
*
Never practiced Yoga
Occasionally
Often
Every day
Do you have any injuries that mean you can't practice yoga?
Payment Details
To secure your space, you must make a non-refundable deposit.
Book Now
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Shared Room Deposit
Full Payment USD 9855 due 60 days before the retreat begins.
$
2,957.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Private Room Deposit
Full payment of USD 15,018 is due 60 days before the start of the retreat.
$
4,505.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Shared Room Full Payment
Enjoy a discount of USD 100 when you pay in full.
$
9,755.00
Quantity
1
2
3
4
5
6
7
8
9
10
Private Room Full Payment
Enjoy a discount of USD 100 when you pay in full.
$
14,918.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Contact Us!
If you have any questions before booking please contact us at contact@wildlifeandyoga.com
Let's go to Kenya!
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