Real-Time Parenting Retreat Registration

Thank you for your interest in the Real-Time Parenting Retreat

Please fill out the form below so we can get to know you.

Please note your room reservations are made through a separate form on the Himalayan Institute website.

Room Reservations(Required)

I understand that accommodations are not included in the registration price and will be purchased directly through the Himalayan Institute website.

Individual or Couple?(Required)

Individual ($399)

Couple ($699)

Your Name(Required)

First Last

Spouse/Partner's Name(Required)

First Last

Best contact phone number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Who lives with you?

Name

Relationship

Please list each name and a brief description of their role and impact in the family.

Overall strengths of the family:(Required)

Overall challenges of the family:(Required)

What takeaways would be most helpful for you from the retreat?(Required)

Special accommodations or requests, including food sensitivities:(Required)

How did you hear about this retreat?

Billing Address(Required)

Same as above

Total

Credit Card(Required)

Cardholder Name

Card Details

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