Clone of SALEM registration form:

Step #1: Fill out the registration form:

(After submitting application you can pay a deposit, and I will reach out to confirm!)I respect your privacy. This information will stay confidential, only I will be seeing this and this information is used for the purpose of helping applicants gain the most benefit for them out of this retreat experience.
Name

First NameLast Name
Date of Birth
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Gender
Preferred Pronouns
Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
What are your social media handles (if applicable)
In a few short sentences, tell me about yourself
How often do you practice yoga? (Beginners welcome! We just want to know about your background to make this experience for YOU!)

Occassionally1-2 times a week3-4 times a weekDailyNever taken a yoga class
How often do you practice Breathwork)? (Beginners welcome! We just want to know about your background to make this experience for YOU!)

Occassionally1-2 times a week3-4 times a weekDailyNever
How often do you practice meditation? (Beginners welcome! We just want to know about your background to make this experience for YOU!)

Occassionaly1-2 times a week3-4 times a weekDailyNever
If you practice yoga, what type of class do you usually attend or style do you practice (ex. flow, hatha, yin, ashtanga, kundalini, etc.) *N/A if you don't practice yoga.
What are your wellness, health, physical and/or soulful goals ?
Have you joined a yoga retreat before? If yes, where and when?
Why would you like to join my Womens New Moon Retreat?
What are some of your fav things in life?
Do you consider your self introverted or extroverted?
What would you like to receive from this retreat?
What would you like to comeback with from this experience?
What are you most excited for on this retreat?
Do you have any physical or health limitations/conditions or injuries I should know about? (i.e heart, blood pressure, depression, anxiety) or any health concerns that you feel may affect your yoga retreat experience:
Are you on any medications?
Is there anything that you may need for accommodation or accessibility?
Any allergies or dietary restrictions?
I am interested in the following bed(s) **Please note that room availability is on a first come first serve basis.

Twin bed (shared room)Queen bed/Sofa bed (shared room)Double Fouton (Single Occupancy)Put me anywhere! I am just excited to be there!
I acknowledge that this is a shared accomodation retreat, which means I will be in a room with another person for sleeping arrangements (exclu. single room), this could include the living room and could include a pull out couch. (all will be comfy I promise!)

Yes
Name of friend(s) you want to be placed with in room (if registering with someone) Please put need placement if alone.
Which form of payment are you interested in?

I will pay all at onceDeposit + a final payment before Feb 23Deposit + 2 scheduled payment installments; Feb 23 + Mar 23Need to discuss alternate payment plan
I have read the pricing options listed on the website (based on accommodation choice) and am aware of the fee associated.

Yes
How did you find out about this retreat?
Anything else you feel I should know?
By checking this box, I acknowledge that I am responsible for my travel/medical insurance if I require it.

I agree
I have read and acknowledge that on this retreat is alcohol free. I will show up for the yoga and activities sober, as well as not bring any on the premises and if this isnt followed I can be asked to leave the remainder of the retreat and not continue to participate.

Yes
I will be responsible, as well as respectful to others in the retreat, the leader and those housing us/around us. If there is inappropriate behaviour, I can be asked to leave the remainder of the retreat and not continue to participate.

I agree
If I damage anything, I will be responsible for any fees associated.

I agree
By checking this box, I acknowledge the $250 deposit is required to hold my spot and is non-refundable.

I agree
By checking this box, I acknowledge that cancellations/payments made are not eligible for a refund.

I agree
Date

MonthDayYear
Date
Signature

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NEXT STEPS:

I am so excited for you to join me at Sidanna in the South Shore! Once you submit this form, you can reserve your spot by completing a deposit at the link below this application or request from me the payment link to pay in full. I will be in touch with you soon to secure & confirm the room/bed you are interested in and to send you all details and next steps.

The magic of the new moon awaits you!!
Should be Empty:

Step #1: Fill out the registration form: