Costa Rica Yoga Retreats with Five Parks Yoga

Your Contact Information

Your Name*

First Last

I prefer to be called by the name:

What name should be written on your nametag?

Email*

Phone (best # to reach you)*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name

First Last

Emergency Contact Phone Number

Are you Attending the Training with Anyone Else?*

Yes
No

Please list names of other attendees you're coming with:

Dietary Restrictions

We will be providing a simple Costa Rican lunch each day. This meal will consist of mostly Chicken, Rica, Plantains, Beans and a drink. If you are not able to eat this meal, you can also take lunch time to go grab your own food on your own. That being said, we would like to know your dietary needs in the event we need to change the menu due to the majority of students needs. Thanks!

Do you have dietary restrictions that will limit your ability to eat our daily lunch (see above)?*

NO!
Yes

Please Check Any Dietary Needs that Apply*

I practice a VEGETARIAN Diet
I practice a VEGAN Diet
I practice a PESCATARIAN Diet
I practice a DAIRY FREE Diet
I practice a GLUTEN FREE Diet
I am allergic to SHELL FISH
I am allergic to NUTS
Other - (list below)

Other Dietary Restrictions

Please list any other dietary information you would like to provide:

Teacher Training Student Information

Please complete this information for our records

Your Contact Information

Dietary Restrictions