Casa Om Fall Ayurveda & Yoga Retreat Registration Form

Registration Form

Please complete the below registration form for the Fall Yoga & Ayurveda Retreat October 9-12, 2026.

Every participant must complete this form and submit their $800 deposit to register. If you are registering as a double with another person, please indicate their name in the appropriate field below. Once you have completed this form, you will be directed to the payment page for the deposit. You may add two deposits to your cart at check out if you wish to only pay once for two people on one reservation (make sure to indicate who you are paying a deposit for in the notes).

Final installment is due August 1, 2026. Save $50 off the registration fee if you pay in full.

If you are paying in full, please pay the $800 deposit and indicate either in this form or in the notes of your deposit that you are planning to pay in full. We will send you an invoice for the remaining amount owed reflecting the discount. Your early registration discount will be reflected in your deposit. If you would prefer to pay with cash/Zelle/Venmo/check, please email Angelina to make this arrangement and save an additional $20.

Name *

First

Last

Email *

Cell Phone Number *

Address *

City/Sate/Zip *

Emergency Contact Name *

First

Last

Please list someone who isn't traveling with you.

Emergency Contact Relationship *Spouse/PartnerParentDaughter/SonSiblingFriendOther

Emergency Contact Phone Number *

If you are sharing a room with someone, please add their name here.

If you are registering to be on the waitlist as an individual looking for a roommate, please indicate you want to be on the waitlist here.

Do you have any diet restrictions? *

Please list any foods you are not allergic to but avoid, or let us know if you're vegetarian, etc. We may not be able to accommodate all requests due to the large group.

Do you have any food allergies? *

We will do our best to accommodate all food allergies.

Are you allergic to coconut, sesame, almond, or any essential oils? *

If you are allergic to any essential oils, please list the specific ones here.

Cell to Do

Do you have any other allergies or contraindicating medications we should be aware of? *

If you are on medications that commonly have food contraindications, are allergic to topical things such as latex, or other types of allergies.

Are you interested in scheduling a massage? *YesNoMaybe

There is not a spa on the premises, but if enough people are interested in massages, we will arrange for a masseuse.

Would you be interested in going on a cave hike for an extra fee?--- Select Choice ---YesNo

If you are attending as a teacher to obtain CEUs, you will not able to attend the hike.

Are you registering as yoga teacher to obtain CEUs? *--- Select Choice ---YesNo

Is there anything else you'd like us to know?

If you are planning to pay with cash, Zelle, or Venmo, please let me know here along with what room you are booking.

Submit

By completing this form and making your deposit, you agree to the terms.

What’s Not Included

Airfare, car rental, transportation to/from the retreat center, taxes, gratuities, travel insurance, water/other activities, additional excursions, massages and spa services.