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New Year's Retreat Registration
December 29, 2019 - January 1, 2020
Bell Valley Retreat
Boonville, CA
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Name
*
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Gender
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Birthdate
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Email
*
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Phone number
*
Your answer
Emergency Contact (name and phone)
*
Your answer
Please briefly describe your background with yoga and meditation
*
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How did you hear about this retreat?
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Your answer
Room selection
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Main house (single)
Main house (double)
Barn house (triple)
Barn house (double)
Women's bunk house
Glamping (Bell Tent)
Required
Roommates (*if applicable)
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Payment method
*
Check made out to 'Monique Haan' / mailed to: 27 Montevideo Way San Rafael, CA 94903
Venmo (@MHWellness11)
PayPal (
moniquehaan@gmail.com
) *includes a 3% service fee unless you use the ‘send to a friend’ option
Required
Dietary Restrictions (all meals will be vegetarian)
*
None
Gluten free
Dairy free
Vegan
Food allergies:
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Injuries / physical concerns:
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Participant Agreement: Please not bring any altering substances to the retreat. Learning to relax into silence with a clear mind/body is integral to staying conscious and connected to the internal shifts of healing that are possible on retreat.
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Liability Agreement: I release Monique Haan from liability, which may arise from any claims by me or any third party in connection with my participation in the retreat.
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