Release Retreat Application Form
Please enter your details below.
Enter Your Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Please Enter Your Email
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example@example.com
City and Country you are in:
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Have you worked with Erika or Hamish before?
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Please Select
Yes
No
Please tell us a little about yourself (the questions we ask are for safety and to ensure we can support you properly):
What area of your life do you want to get better results in?
How long has this been an issue for you?
Have you done any previous self development work? If so, what was the outcome?
What do you hope to gain from attending this retreat?
Why do you wish to work with Erika and Hamish?
How are you in group settings?
Do you have any allergies?
What are your dietary requirements (vegan, nut allergy etc)
Are you taking any medications currently?
Are you seeing a therapist/counselor/healer at the moment?
Have you been clinically diagnosed with any mental health conditions?
Have you been clinically diagnosed with a medical condition (diabetes, high blood pressure etc)?
Is there anything preventing you from low impact physical movement?
Are you currently Pregnant?
Are you willing to travel to Melbourne, Australia for this retreat?
Is there anything else you would like us to know about you?
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