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Heart Broken Open - Retreat Application

What's your name?

Would you like to share your pronouns?

What's your email address?

What's your phone number?

How would you like us to contact you?

How would you like us to contact you?
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Why now for you? What has you saying yes to this retreat right now?

What do you hope to land in—on the land, within yourself, and with this retreat?

What do you wish to walk away with? Is there an intention you’d like us to hold witness to?

Is there anything you’d like us to know about you or what you are navigating right now?

What, if anything, might stand in the way of you fully leaning into the experience and receiving what you came for?

Do you trust yourself to regulate if something gets activated in you? (Activation is not “bad”—triggers often point to unspoken truths.) If not, are you committed to leaning into the support available through us and through the retreat container by asking for care?

Where will you be traveling from, and do you need any support or information about getting here? (Natasha will support with logistics.)

What is your first-choice and second-choice for accommodation?

What is your first-choice and second-choice for accommodation?
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What is your first-choice and second-choice for accommodation?

What is your first-choice and second-choice for accommodation?
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Would you prefer to pay in full (at the current lowest rate) or with a payment plan?

Would you prefer to pay in full (at the current lowest rate) or with a payment plan?
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Are you okay with us reaching out to you via phone call or text for communication?

Are you okay with us reaching out to you via phone call or text for communication?
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This retreat takes place at an off-grid eco-centre. You will find everything you need here, and nothing you don’t. We honor the land and work with its seasonal resources, which sometimes means being especially mindful of water and energy use. Are you willing to honor and participate in this way of being with the land?

Have you participated in retreats or group healing spaces before? If so, what was supportive and what was challenging for you?

Do you have any physical, dietary, or accessibility needs we should be aware of to best support you?

Please provide the name and phone number of someone we could reach in case of emergency.

Do you have any questions for us?