Personal Retreat Registration

Please complete one registration form for each person. All fields marked * must be completed before the form can be submitted.

Please refer to our online calendar for available times.
Arrival Date*
MM
DD
YYYY
Departure Date*
MM
DD
YYYY
Name*
FirstLast
Gender
- Female
- Male
Email*
An automatic confirmation will be sent to this address when you submit this registration form. If this is a surprise gift for someone, please enter the recipient's email address in the "Additional comments" field at the end and enter your own email address here.
Phone (Day)
Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Emergency Contact Information
Contact Name
FirstLast
Relationship with Contact
Contact Phone
Contact Email
How did you hear about us?*
Please enter any other details or comments that will let us know how we reached you:
We offer a lacto-vegetarian yogic diet. While we do our best to provide options, we cannot guarantee that all restrictions can be accommodated.
Please list any dietary restrictions:
Please indicate your levels of yoga:
Yoga Postures*
Breathing/Pranayama*
Meditation*
Please list any health conditions or issues:
(ie. high blood pressure, active asthma, pregnancy stage, active injuries and prescribed medications that you will be taking at the time of the program.)
Rates per night
Rates are per person per night and include accommodation, all facility usage, vegetarian meals, tea bar, and scheduled yoga classes. HST will be added to all fees. While every effort will be made to provide your first choice for accommodation, on-site options fill up fast, so if you are willing to consider other accommodation choices, please select a "2nd Choice".
Shared accommodation rates are only available for personal retreats if you are registering with a friend
Friend's Name (if you are sharing accommodation)
FirstLast
First Choice*
HST will be added to these fees.
Second Choice
If none of your choices is available, would you like to be placed on a waiting list?*
- Yes
- No, thanks
Wellness Centre
Interested in receiving a treatment at our on-site Ayurveda Wellness Centre? We recommend booking now to ensure that your preferred times are available.
Treatment 1 Requested:
Treatment 1 Date*
Preferred Start Time*
Treatment 2 Requested:
Treatment 2 Date*
Preferred Start Time*
Treatment 3 Requested:
Treatment 3 Date*
Preferred Start Time*
PAYMENT METHOD*
- PayPal
- Credit Card (By Phone)
- Personal Cheque/Money Order
All fees must be paid in full to hold your reservation. Rates are quoted in Canadian dollars and include all applicable taxes. If you select PayPal as your payment method, a PayPal invoice will be emailed to you. If you wish to phone in your credit card information, please call us at 250.537.2326. Your credit card number will not be kept in our files subsequent to processing your payment. Please do not under any circumstances send your credit card information by e-mail. We also take Canadian or US cheques and/or money orders. Payments in US funds will be credited toward program fees at the prevailing exchange rate.
Please read the Salt Spring Centre's Cancellation Policy
Cancellation Policy*
- I have read the cancellation policy and agree to its terms
If there are additional comments you would like to add to your registration, please enter them here:

Personal Retreats at the Salt Spring Centre of Yoga

Personal Retreat Registration

Emergency Contact Information

Please indicate your levels of yoga:

Rates per night

Wellness Centre

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