Mini and Me Moon Retreat Registration

Please complete all of the following information fully. Return this Registration Agreement, together with your payment to Aviana. By completing and submitting all attached documentation as required, you, the participant, represent that all information is true and complete, and that you agree to be bound by all of the conditions established by Aviana for this retreat.

Mini & Me Moon Retreat Registration

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Name *

First

Last

Parent Date of Birth *

Child Name *

Child Date of Birth *

Phone Number *

Email *

Address *

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Line 2

City

State

Zip Code

Country

Emergency Contact

Name *

First

Last

Phone Number *

Condition of Health

Please list any and all health conditions (mental, physical, emotional) that may effect your participation in this retreat. If there are none to list, please write 'none': *

Are you currently being medically treated for any of these conditions? (If not applicable, please write n/a) *

Please describe any physical injuries or recent surgeries: *

Any dietary restrictions or allergies? *

Getting to Know You

What are you excited about the most for this retreat? *

Cancellation Policy

This event has a 48- hour cancellation policy, in the event that you are unable to keep your reservation, please contact Holly immediately (970) 988-6168 or avianayoga@gmail.com at least 48 hours prior to the start of the event. There are no refunds or credit granted for cancelations within 48 hours of the start of the event.

I have read the cancellation policy *

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Submit

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Payment Options

Once you have submitted your registration information, please click below on one of the following payment options to complete your registration, or to avoid the credit card fees (4%), you may submit your payment of $133 via Zelle to avianayoga@gmail.com OR friends and family Venmo to aviana_yoga.

Pay with Card

Retreat Registration

Mini & Me Moon Retreat Registration

Emergency Contact

Condition of Health

Getting to Know You

Cancellation Policy

PLEASE CLICK SUBMIT ABOVE BEFORE PROCEEDING

Payment Options

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