Retreat Screening

Venus Rising: Screening Questionnaire
Thank you for your interest in joining Venus Rising: Cultivating Confidence and Desire. This transformative retreat is designed to empower women to reclaim their sexuality, confidence, and pleasure in a deeply immersive and supportive environment. In order to create the most effective and healing experience, we ask that you complete the following questionnaire to help us ensure the retreat is a good fit for you.

Are you applying for Venus Rising I: July 10-13 or Venus Rising II: August 7-10*

July 10-13August 7-10 (only 2 rooms left, 1 private & 1 shared with two single beds)

Name*

First NameLast Name

Birthday*

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

How did you hear about our retreat?

Do you currently have or have you had any form of therapy experience (e.g., individual therapy, group therapy, trauma counseling)? If so, please describe:*

Have you participated in any other retreats or personal development intensives? If yes, please explain:*

What types of therapeutic or healing practices have you engaged in that may help you in this retreat experience (e.g., mindfulness, bodywork, somatic practices, etc.)?*

Are you currently in therapy? If yes, please briefly tell us about what’s working? What’s not?*

Do you feel emotionally stable and capable of engaging in deep emotional and sexual exploration during the retreat (not hands on, all verbal processing)? Please elaborate.*

Venus Rising is about reconnecting with your desire, releasing shame, and cultivating self-assurance in your sexuality. Which of the following most resonates with you? Choose all that apply.*

I feel disconnected from my desire and am seeking to reconnect with my passion and pleasure.I am ready to release shame or embarrassment holding me back from fully embracing my sexuality.I want to explore and better understand the landscape of my own pleasure.I’m looking to deepen my sexual relationship with myself or a partner.I struggle with overthinking and want to learn how to be more present and experience pleasure fully.I desire to communicate my sexual needs and desires more confidently.I feel the need to prioritize my pleasure and well-being.

Please describe any emotional, mental, or physical barriers you are currently facing that may impact your ability to fully engage in this retreat.*

What are your primary goals or intentions for attending this retreat? What do you hope to gain from this experience?*

This retreat will involve emotional processing and deep sharing within a group of women. How comfortable are you with vulnerability and sharing your personal experiences in a group setting?*

Are you open to working closely with other participants and offering support to others in a community setting?*

How do you typically navigate conflict or discomfort in group settings? How do you approach being supported by others?*

Do you have any current physical, mental, or emotional health concerns that may affect your participation in the retreat? If yes, please provide details:*

Are you comfortable with engaging in embodied activities (e.g., dance, gentle movement, play)? Please share any considerations you may have.*

Do you have any dietary restrictions or preferences we should be aware of?*

Venus Rising is a "dry" retreat, meaning no alcohol or recreational substances will be allowed during the duration of the event. How do you feel about participating in a retreat with this policy?

Do you acknowledge & agree to this policy?

YesNo

In order to create a space of deep presence and connection, we ask that cell phones be used minimally during the retreat. There will be designated times for phone use if necessary, but we encourage participants to fully immerse themselves in the experience. How do you feel about limiting your cell phone usage during this retreat?

Do you acknowledge & agree to this policy?

YesNo

What accommodations do you prefer?*

Private roomShared room with friendShared room with matched participant (organizers may be able to connect you with another person interested in sharing a room, but there are no guarantees. If no participant is able to match with you for shared accommodations you will be placed in a private room at full fee. By selecting this you agree to these terms.)

If you chose shared room with friend, what is their name?

Is there anything else you'd like us to know that will help us assess if this retreat is the right fit for you?*

By submitting this application, you acknowledge that you are not seeking individual therapy through this retreat, and understand that the facilitators will not be providing individual therapy but will guide you through educational and group healing processes. Do you accept these terms?*

YesNo

Thank you for completing this questionnaire!
We will review your responses and get back to you shortly. If you are selected to attend the retreat, you will receive further details and instructions.

Therapy & Healing Background

Personal Readiness & Alignment

Group & Community Dynamics

Health & Well-Being

Alcohol & Substance Use

Cell Phone & Technology Use

Final Thoughts