Name
*
First Name
Last Name
What is your birthdate?
*
MM
DD
YYYY
Phone
*
(###)
###
####
Email
*
What is your social media handle?
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
(###)
###
####
Emergency Contact Email
*
Which accommodations would you prefer?
*
We will be contacting you to set up a zoom call to solidify your space. What is the best way to reach you?
*
During Women in Rhythm you will be invited to unplug from work, social media, & phone in order to best uplift and support your full presence in this immersive space.
*
We are choosing to hold Women in Rhythm as a substance free and fully present space. We ask each who participate to do the same.
*
What does the landscape of your life currently look like?
*
How would you describe your relationship with your body?
*
This retreat will be an intimate container and feature bodywork. Are you comfortable receiving therapeutic touch from practitioners and other attendees?
*
You are sovereign and may absolutely decide in the moment what feels right for you.
We will be encouraging all who feel comfortable being witnessed in full or partial nudity to join and follow along in certain ceremonial spaces as we honor and give love to our own bodies. Do you have any questions or concerns about this segment of our retreat?
*
Do you have any dietary needs that we need to be aware of?
*
Food will be prepared in an organic &/or local fashion that will contain meat & could be adapted if desired. We strive to eat whole foods, both plant & animal. We will stay away from most anything processed. Everyone has vastly diverse dietary needs and we will do our best to accommodate, please tell us about yours.
If you are applying with a friend or relative, please include their name here & your relation:
Is there anything else that you'd like to share with us as we review your application?
*
FINANCIAL AGREEMENT
*
A deposit of $555 is required to reserve your space upon agreement.
Full financial commitment is required to be paid in full, a week prior to the set date of the immersion. Refunds are available up until 30 days before the start of the retreat, if we are able to fill your space with another attendee.
Payment plans will be available upon request.
