USER ACCOUNT CREATION | Cloud Mountain Retreat Center

The details you enter here will auto-fill on the Retreat Registration Form and Donation Form, saving you time and repetition. You can overwrite any auto-filled field at any time, and you can update your account as needed by going to the Account Update Form.

Upon submitting this form you will receive an email with your login details. You will also be automatically logged in and returned to the Retreat Registration Form.

CONTACT INFORMATION

Name*

Email*

Please note that this is the email to which we’ll send all retreat-related correspondence.

Username*

Password*

Enter Password Confirm Password

Strength indicator

Address

Please enter letters and numbers only in the address fields. For US and Canadian addresses please enter no more than 2 letters in the State field. Registration may fail if any special characters are entered (#, -, comma, etc).

Cell Phone

Please enter numbers only, no dashes or special characters.

Alternate Phone

Please enter numbers only, no dashes or special characters.

Do you prefer email or text for retreat-related communications? (Please be aware that most communications are emailed by default.)

Text

Occupation

Age

Gender

Please indicate your gender identity.

Male

Female

Other

EMERGENCY CONTACT INFORMATION

Medical Doctor

Doctor Phone Number

Emergency Contact Name

The contact you provide should be someone who is able to physically connect with and check on you.

Emergency Contact Phone Number

PERSONAL INFORMATION

Do you snore loudly?

Yes

Do you use a CPAP?

Yes

On a scale of 0 – 10, with 10 signifying excellent ability and 0 signifying complete inability, please rate your ability to walk long distances (500 feet or more at one time) several times per day.

On a scale of 0 – 10, with 10 signifying excellent ability and 0 signifying complete inability, please rate your ability to walk uphill several times per day.

Do you need an accommodation?

Do you have any issues, including but not limited to physical differences, health, or mobility, that may impact your housing, siting, facility usage, yogi job or overall ability to fully participate in the entire retreat? This information will help us in assigning you a room and ensuring you a comfortable retreat experience.

Yes

Please explain your situation.

Do you have any food allergies or dietary restrictions?

We serve a lacto-ovo vegetarian menu (contains dairy and eggs.)

Yes

Diet Details

If you have a severe food allergy please indicate this below.

Dairy-free

Wheat-free

Vegan

Peanut Allergy

Other

If other, please describe:

Additional Details

Use this box to alert us to severe food allergies, including the severity of your reaction, or additional dietary restrictions.

MEDITATION EXPERIENCE

How long have you practiced?

In what traditions?

Given the choice, would you prefer to use a chair or cushion during your retreat?

Chair

Cushion

Either – I’m flexible

Phone

This field is for validation purposes and should be left unchanged.