Retreat Application

Application Form - Align Your Life Retreat

Yoga Forest, San Marcos, Guatemala January 11-18, 2025
Full name*

First NameLast Name
Birth Date*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
E-mail*
Phone Number*
What’s your preferred method of contact?*

EmailPhone CallText MessageWhat’s App
Health Details

In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential.

	Yes	No
Do you have or have you ever had any physical health problems, eg. diabetes, epilepsy, high blood pressure?*
Do you have or have you ever had any mental health problems, eg: anviety, depression, PTSD?*
Are you now taking any prescribed medication?*
Are you now taking any of the following drugs: barbiturates, amphetamines, cocaine, heroin, hallucinogens?*
Do you have muscle or joint problem that could worsen by a change in your physical activity?*
Do you smoke?*

If you answered "Yes" to any of the questions above, give details of all occurrences. Include the following: dates, frequency, type, amount etc below
Do you have any dietary requirements/allergies?*
Preferred sleeping arrangement*

Private SoloPrivate CoupleDouble SharedQuad Share
If you have any questions that you wish to discuss prior to participating in the retreat, please do so before committing yourself to the program.

I realize that retreats held by Bhakti Beauty require my mental and physical health and I certify that I am fit to undertake it.

I understand there is a $500 non-refundable deposit, and the remainder of my investment is due by December 21, 2024.
Thank you.

Our founder, Bia Rodriguez, will contact you to book your place upon acceptance of your application.
Initials*

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