Couples Retreat Registration Form

All your information remains confidential


Please elaborate

Personal Info

The information requested below is very important. It will help the Group Facilitator(s) to work with you more effectively. The information will only be seen by the Group Facilitator(s) and the Group Organiser.

Please describe any self development work you have done
Have you had any previous experience of Tantra or relational workshops? If the answer to this question is “Yes” please outline this experience briefly.
Please describe significant events from your family environment, your upbringing and other difficulties you have experienced in your childhood and adult life that you feel may be relevant for your process.
The group includes some physically active structures (some meditations and exercises and dancing). Please let us know if this will present any physical difficulties for you:
Please tell us about any health issues and/or infectious diseases you may have. Please also tell us if you are on medication of any kind (please specify).:
Please indicate below if you have any history of psychiatric treatments or if you are currently taking any psychiatric medication:

I have read and agreed to the Waiver and disclaimer and the Cancelation Policy

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