Coconut Spice Bali Chakra Yoga Retreat Registration Form

Bali Ascend Yoga & Freediving Retreat

26th September - 2nd October 2025
Thanks for putting yourself first and enquiring about our exciting, upcoming Bali Ascend Yoga & Freediving Retreat Sep 26th - Oct 2nd.

You are here because you are ready to shift some old stories and step into the shining light you are!

Please complete your details below and feel free to include any questions/ concerns you might have and any blocks to joining us on this powerful journey together in paradise.

I will be in touch to give you a call to discuss how we can make this happen for you and whether this might be a good fit for you.

Lots of love, Chrissie x
Name

First NameLast Name
Email (Please double check spelling)
example@example.com
Birthdate

MonthDayYear
Date
Mobile Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Postal CodeCountry
What sparked your interest in our Bali Ascend Yoga retreat?
What are you hoping to get from the Bali Ascend retreat? Do you have any goals or visions for the time away together?
Is there anything that you see that might block you from achieving this goals?
Are there any blocks that are coming up around deciding if this is something that you can make happen?
Have you been on a transformative yoga retreat before?
Are there any aspects of the retreat that scare you or are perhaps making you doubt if this is truly for you?
Do you have any health limitations or physical injuries? Please indicate if you have any major health issues (eg high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, etc.)
Are you taking any medications? Please list
How did you learn about the Bali Chakra Healing Retreat?
Do you have any further questions?
Should be Empty:

Bali Ascend Yoga & Freediving Retreat