Residential Program

* These fields are required

1 Welcome

2 Choose Dates

3 Choose Accommodations

Enter the TOTAL number of people in each accommodation type, including children.

Select a price.

$2,000.00 – 30 Days Single Room

Guests

$2,850.00 – 30 Days Apartment

Guests

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4 People in your group

Guest 1		First Name* Last Name* Gender* Email*
Guest 1		First Name* Last Name* Gender* Email*

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5 Participant Information

Spiritual Name
Gender *	If you are staying in a dorm or double shared room and you selected Other Gender, please explain in the Comments box below under Additional Information.
Birth Date *
Have you been at the Ranch before? *	YES NO
How did you hear about us? *
If you selected other, please describe...

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6 Contact Information

Cell Phone *
Alternate Phone
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *

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7 Room Choice

Residential room options *	$2000/month in a private room $1550/month in a tent Choose one of the room options above. Acceptance to the program is pending a successful interview.

8 Emergency Contact Info

Emergency Contact Name *
Emergency Contact Relationship
Emergency Contact Phone *
Emergency Contact E-mail
Do you have any food allergies or dietary restrictions? *
Dietary Restrictions (Select all that apply)	Vegan Gluten-Free Dairy-Free None

9 Additional Information

Medical Issues *	If none, please enter 'none'.
Prescribed medications *	If none, please enter 'none'
Requested Roommate
Will you be bringing children 12 and under?
Child discounts	Depending on the age(s) of your child(ren), you may be eligible for discounts on your reservation. Please call us for more information at 845-436-6492.
Comments or Special Needs
How will you arrive? *	Private Vehicle (Arriving before 4:00 PM) Private Vehicle (Arriving between 4:00 - 6:00 PM) Private Vehicle (Arriving after 6:00 PM) Bus (Arriving at 12:47 PM in Woodbourne) Bus (Arriving at 2:57 PM in Woodbourne) Please call us if your transportation plans change. For bus arrivals, we will pick you up from the Woodbourne Fire Station in Woodbourne (last stop on local bus). Please call when getting on the bus in NYC to confirm bus time.
Respective Skills (check all that apply) *	Marketing Gardening Cooking Construction Housekeeping Office Computers Other
Other Skills to Share? *
Skills & Volunteer Interests *
Please describe your experience with yoga and meditation *
Why would you like to come to the ashram? *
What does Karma Yoga mean to you? *
What do you hope to achieve during your stay? *
Please tell us a little about yourself *

10 Agreements

Ashram Guidelines and Cancellation Policy *	I have read and agree to the Ashram Guidelines and Cancellation PolicyPlease read the Ashram Etiquette, Guidelines and Cancellation Policy
Email newsletter *	Please send me the email newsletter No thank you
Photo Release *	I have read and agree to the Photo Release I have read the Photo Release and prefer not to be photographed Please read the photo release policy
Liability Release *	Agree?I, the undersigned, fully understand and agree to the following: 1. That I am participating in Yoga classes, workshops and/or courses offered by Sivananda Yoga Vedanta Center (SYVC), a nonprofit organization. I recognize that any physical exertion may be strenuous and may cause injury. I am fully aware of the risks involved. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in these classes, courses and workshops if I have any question as to my ability to participate in Yoga exercise/philosophy classes, meditations and other activities. 3. I hereby state that I am physically and mentally fit and have no medical condition which would prevent my full participation in these classes. Any medical conditions that I am aware of are listed or explained above. 4. I voluntarily participate in Yoga instruction taught by the Sivananda Yoga Vedanta Center. By signing my name on this form, I release the Sivananda Yoga Vedanta Center and its agents from liability for any injury to my person or damage to my property incurred while attending yoga classes online or onsite. I have reported any restrictive physical disorder to the staff and/or teachers of the Center.

11 Donate

$

12 Payment Information

PLEASE NOTE: if you would like to pay with a gift certificate, or use a personal credit from a previous stay, you MUST call us as soon as you book your reservation at 845-436-6492

Sub Total	$0

Donations	$0

Taxes	$0

Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

Remaining Balance	$0

First Name
Last Name
Address *
City *
State/Province *
Postal/Zip Code *
Country *
Card Type
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card

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