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Solo Dark Room Retreat
Dear friend,

Please answer the questions below completely so we can best serve you in the retreat.
Name*

First NameLast Name
E-mail*
Phone Number*

Country CodePhone Number
Age*
Gender*
Please tell us about any experience you have with Darkness, isolation or meditation. Where have you done these?
Which dates are you interested in attending? (you don’t need to do the whole period)*

January 26 - Feb 5thFebruary 19 - March 9thMay 12th - 26thSeptember 14th - 27thNovember 2nd - 15th
Do you have any movement practices? (Qigong, yoga, calisthenics etc)
How many days do you think you might want to do?
Which room/s are you interest in?*

Tenebrum - Latin - meaning ‘shadows/darkness’A spacious room with space for a yoga mat, a super king sized bed and open ensuite bathroom with a showerCaiomhnoir -A spacious room with space for a yoga mat, a super king sized bed and adjacent ensuite bathroom with a bath and showerXuanshi - A spacious room with space for a yoga mat, a super king sized bed and adjacent ensuite bathroom with a bath and showerAluna - A smaller room with room for a yoga mat a single bed, and ensuite bathroom with a shower
Do you have any dietary needs/ preferences?
Do you have any food allergies?*
What is your intention for immersing in Darkness?*
Anything else you think we need to know?
To help us prioritise the development of the services we offer, which of the following are practices that appeal to you to work with in Darkness?

Taoism/ MeditationBreath WorkLucid DreamingShamanic practices or Higher Sense Perception developmentFasting or CleansingShamanic dietas
How did you find out about this Darkness retreat?
Please provide complete health information below.

Your answers will be kept confidential
Do you have any current physical health challenges, conditions or diagnoses, or do you have any significant ones from the past?*
Are you on any medication for anything, or have been in the the past 3 months? Please write details ie names of any medication you are on, the dose and how long you’ve been taking it for.*
Do you have any addictions? (include drugs/substances, sexual, gambling, food etc)*
Do you have any current significant psychological conditions/challenges, or have you had any significant ones in the past (psychosis, sectioning, or anything which required you to lean into pharmaceuticals, therapy or leaning strongly on friends and family to function).*
Please provide us with the name and contact details of an emergency contact for you
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Country CodePhone Number
Thank you for expressing interest. We will contact you soon with any questions we have about your health, and to book in available dates

Greg
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Solo Dark Room Retreat