Loka Yoga School
Explore.  Travel.  Embrace!
Retreat Application Form 
*Mandatory field

* Full Name:
* Email address:
* Country Code:
* Country:
* Date of Birth (Day/ Month/ Year):
*Retreat Date and Location:
* Full Home Address
* Passport Number:
* Phone Number:
* Are you male or female?
* Do you have any physical limitations/injuries that may prevent you from joining a yoga practice or for sitting for extended periods of time? If yes, please describe:
* Current Occupation:
* Preferred Name:
* Are you currently taking any form of medication?
* How did you hear about our retreat?
* What do you hope to get out of this retreat?
* Have you got any fears or apprehensions about the upcoming retreat?
* Facebook / Instagram account name?
* Have you ever received professional medical treatment due to any psychological condition?
* Is there anything else it would be helpful for us to know about you or your past? (e.g. social therapy, anxiety issues, etc)
* EMERGENCY CONTACT - Full name
* EMERGENCY CONTACT - Relationship to you
* EMERGENCY CONTACT - Email address
* EMERGENCY CONTACT - Contact phone number (please include country code)
Submit
Participating in one of our yoga retreats can be a transformational and life-changing experience.
By completing our online application form and submitting your payment, you are hereby taking full account and responsibility for your own actions and any respective outcomes before, during and after the event. 
Our retreats are drug and alcohol free.  All payments are non-refundable.
Loka Yoga reserves the right and full entitlement to dismiss anyone who is seen to act or behave in what they consider inappropriate.​