Registration Form 
To be completed before making initial deposit or full payment to secure a room at the Costa Rican Reset

Yoga & Mindfulness Retreat January 27th - February 2nd, 2024 with Kleidoscope Yoga LLC


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Full Name and name you prefer to be called if applicable *
What is your best email for retreat communication? Add it below and please whitelist amberkleid@kleidoscopeyoga.com to be sure you receive all updates.
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Would you like the above email to be included in the Kleidoscope Yoga newsletter community? As a thank you, you'll receive a free gift to help you show up more mindfully in your world so you can ease stress, communicate with confidence, and begin to set sacred boundaries for better health. If another email is better for you, include it in the "other" option.  *
Please provide us with your best phone number for emergencies and general communication through WhatsApp. *

Terms & Conditions 

These Terms & Conditions are a binding contract between you and Kleidoscope Yoga LLC with your first payment towards a yoga retreat. If you are booking a trip for multiple people, then all travelers in that booking will be deemed to have read and agreed to the traveler’s terms and conditions. Please click HERE to read and review our Terms & Conditions. You may download a copy for your records.

I have read and understand the complete Terms and Conditions linked above and by writing my full and legal name below I agree to be bound by its terms. 
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Our meals will be vegetarian with the possibility of local fish. Please include ANY dietary Restrictions and any Allergies. If none put N/A
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If booking a shared Private Suite for two people who are traveling together, please submit the name of your roommate here. Understand that if your roommate chooses not come and you choose to not fill the space, you will be charged the single private room rate when full payment is due.
Please tell me about your experience with yoga: 
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Is there anything special I should know about you? Such as being pregnant, recent postpartum, injury, physical limitation, or anything else that could help me make your experience more comfortable & enjoyable. This information is confidential unless otherwise stated.
What are your goals with this retreat? I'd like to hear from you!
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Do you have any questions for Amber?
Name, email and phone number of emergency contact
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Auto-debit Agreement for Balance Due  

Please note that all $1000 deposits are non-refundable and non-transferable. Please refer to the Terms & Conditions provided above for a full explanation. Upon completing your reservation your credit card will be securely stored in our booking system. 

For all EarlyBird ($200 savings) deposits made by 10/31/2023, you are agreeing that the card you pay with today will be charged your balance on 12/16/2023. 

For all deposits made for the Retreat after 10/31/2023 (forfeiting EarlyBird pricing), you are agreeing that the card you pay with today will be charged your balance on 12/16/2023. 

You will receive an email reminder one week before your balance due is automatically charged to the card on file used for your deposit. 

If you are registering after the final balance deadline (12/16/2023), your full payment is due upon signup. 

By providing your initials below you agree and understand the card used for your deposit will be automatically charged any balance due.


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By adding your full name and today's date below you agree that your answers to the above statements are true to the best of your knowledge, you have read and agreed to above Terms & Conditions, and you recognize Kleidoscope Yoga LLC will do their absolute best to accommodate any special requests but cannot make any guarantees. *
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