Registration | Soulful retreats

Full Name *

Email address *

Phone Number *

Emergency contact - full name, relationship to you and phone number *

What room type would your prefer? We will confirm availability within 24 hours of registration. *

Gladak Room $2222pp (2 sharing)
Gladak Suite $2222pp (2 sharing)
Gladak Hut $2722pp (private)
Gladak Suite $2722pp (private)
Gladak Bungalow $2722pp (private)

If you are room sharing do you have any preferences of your room mate? Eg quiet, goes to bed early, outgoing, someone who likes a lot of personal time etc *

If you are attending with someone please write their name below *

Please advise any dietry requirements below *

There is a credit to spend each meal, including breakfast, lunch and dinner (meals are indicated on the itinery). You can absolutely go over your credit if you feel like more indulgence and really spoiling yourself. The extra will be charged to your room *

I agree

What called you to this retreat and what's your main goal of coming? *

I understand that flights, insurance and visa are NOT included *

Flights not included
Insurance not included
Visa not included

I will provide a copy of my flights and insurance once purchased *

Yes

If I have not paid for my flights and insurance yet I will need to get them by 6th September at the latest and that if I fail to do so I do put my spot at risk and the deposit is non refundable *

I understand and agree

I understand that insurance for FLIGHTS AND THE RETREAT is mandatory *

Yes

I understand that all travel to and from the retreat is my responsibility *

Yes

Your passport must be valid for at least 6 months from the date you arrive in Indonesia (Bali). Is your passport valid? *

Yes

I understand the deposit is non-refundable *

Yes

Please contact Kayu Mama directly at reservations@kayumamabali.com if you require the following (please note they are subject to availability):

Pre or post accomodation
Transfers to or from the retreat (per car price)
Any treatments (please see itinery or chat to us for allocated times)

Do you have any medical conditions we should be aware of? If yes please give details *

Are you currently taking any medications? If yes please give details *

Do you have any injuries or physical limitations? If yes please give details *

I agree to communicate openly with the facilitator if I feel overwhelmed, need support or have a problem *

Yes

I understand that this retreat is strictly an alcohol and drug free event *

I understand and agree

How did you hear about this retreat? *

Is there anything else you’d like us to know to support you? *

Thankyou so much for taking the time to fill out this registration. Please feel free to reach out if you have any questions. Cathy 0432175200 or Georgia 0401468863