PERSONALIZED RETREAT INQUIRY FORM
Thank you for your interest in crafting a unique and transformative retreat experience with us. This inquiry form is your first step in designing a personalized journey tailored to your preferences and interests. Make sure you were able to view our catalog that lists more details about the specific experiences that will be referenced in this form. If you haven't seen the catalog, please refer to jolyninspiral.com/personalized-retreats to find the catalog linked there. Please provide details about the type of experiences you're seeking, the length of your retreat, and any specific needs or preferences. Once we receive your form, we’ll connect with you to start planning your ideal retreat in the heart of Peru. For any additional questions, please reach out to jolyninspiral@gmail.com
Your Information
Name
*
First Name
Last Name
Email
*
Phone Number
-
Area Code
Phone Number
Preferred Method of Contact - Check all that apply.
*
Email
Phone Call (WhatsApp)
Text Message (WhatsApp)
Travel Information
Travel Start Date
Month/Day/Year
Travel End Date
Month/Day/Year
If you don't have specific dates, then are you planning your trip to Peru?
What is your intention for planning this Personalized Retreat?
Are your travel dates flexible?
Yes
No
How many days would you like us to support you during your stay?
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1-3 days
4-7 days
1-2 weeks
2+ weeks
Other
What type of experiences are you interested in? (Check all that apply)
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Cultural Experiences (e.g., market tours, weaving demonstrations, farm tours)
Adventure Experiences (e.g., hiking, mountain treks, hot springs)
Spiritual Quests (e.g., sacred ceremonies, breathwork, shamanic journeys)
Combination of the above
Other
Of all of the cultural experiences that are listed on the catalog, which ones are you most interested in? (Check all that apply)
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Market & Food Tour
Cusco Tour
Traditional Huatia
Despacho Ceremony
Farm Tour of Local Medicinal Plants
Organic Farm Tour and Farm-to-Table Lunch
Day in Community with Weaving Demonstration
Silver Jewelry Making with Local Association and Kids
Of all of the adventures that are listed on the catalog, which ones are you most interested in? (Check all that apply)
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Huchuyqosqo
Pitusiray
Naupa Iglesia & Perolniyoc
Inti Punku
Salineras de Maras
Urco Ruins
Moray
Machu Picchu
Ollantaytambo
Killarumiyoq
Saqsaywaman & Temple of the Moon
Ausangate + Hot Springs
Lares + Hot Springs
Pisac Ruins
Of all of the spiritual quests that are listed on the catalog, which ones are you most interested in? (Check all that apply)
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Shamanic Drum Making
Huachuma Journey
Guided Breathwork
Sound Healing Ceremony
Ecstatic Dance Experience
Temazcal Ceremony
Hot and Cold Therapy Experience
Ayahuasca Ceremony
Which option or component of the retreat are you most excited about?
Will you be traveling alone?
Yes
No
Are you interested in being picked up or dropped off from the Cuzco airport?
Yes
No
If you plan to travel with others, how many would be in the group?
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Are there any travelers under the age of 18 in the group?
*
Do you have any dietary preferences or restrictions?(e.g., vegan, vegetarian, gluten-free, allergies)
Are there any specific activities or experiences you'd like included that aren't listed?
What is your Personalized Retreat Budget (USD) per person?
*
Less than $1,000
$1,000- $1,500
$1,500- $2,000
$2,000- $2,500
$2,500- $3,000
$3,000+
Other
Anyone require handicap accessible accommodations, have special needs, dietary restrictions, allergies, or medical concerns you want me to be aware of?
Example: We need a wheelchair accessible room, child allergic to peanuts, etc. If multiple rooms - please indicate which
How did you hear about us?
Word of mouth
Social media
Website
Other
14. Any other details or special requests you'd like us to know?
.
Please verify that you are a human.
*
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