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- Cambodia Retreat Jan 2027
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Cambodia Retreat

Application

January 3-11, 2027

This is a curated and intentionally held experience.

We ask all participants to complete a brief application so we can ensure a good fit for the group.

You don’t need to have everything figured out — a sense of curiosity or resonance is enough.

All information shared is kept confidential and helps us ensure a supportive and aligned group experience. We may reach out for a short follow-up conversation if needed.

This retreat is not a substitute for medical or psychological care. By completing this form, you acknowledge responsibility for your own well-being throughout this experience and agree to seek appropriate support if needed. We are here to support your experience within the scope of this work.

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First Name *

Last Name *

Date of birth

Email *

Phone *

Country

Country

What draws you to this retreat? (short paragraph)

Is there anything specific you are hoping to explore or shift? (optional)

Have you participated in any of the following before? Please select all that apply.

Therapy

Constellation Work

Meditation and/or Embodied Practices

Ashtanga Yoga (including Mysore-style)

Retreats

None of the above

Please briefly explain your experience below

How would you describe your current emotional & mental wellbeing? (Short answer)

Are you currently taking any medications that support your mental or emotional wellbeing? Because this retreat takes place in Cambodia, please be aware that some commonly prescribed in other countries may be restricted or not permitted. We encourage you to check in advance and reach out if you have any questions or specific needs; we're happy to support you in preparing.

Yes

No

Prefer not to say

If yes, anything we need to be aware to support your experience?

Are there any physical conditions, injuries or health considerations we should be aware of to support your participation (movement, travel, climate, group activities)?

Yes

No

Prefer not to say

If yes, please share anything you’d like us to be aware of so we can best support you.

Are you currently navigating any significant emotional or psychological challenges that may impact your ability to participate in a group retreat setting? If yes, we may reach out to ensure this experience feels supportive and aligned for you.

Yes

No

Prefer not to say

Is there anything related to your physical or emotional health that you would like us to be aware of to better support your experience?

Do you currently use any substances (alcohol, marijuana, recreational drugs etc.)? This helps us create a safe and supportive group environment.

Yes

Occasionally

No

Prefer not to say

Are you open to participating in a group setting that includes shared experience and personal reflection?

No

Yes

Not sure/Somewhat

Would you like to explore a personalized payment plan?

No

Yes

Maybe/ I'd like more information

Is there anything else you'd like us to know?

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Application & Registration

We invite all participants to complete the application above so we can ensure a well-aligned and supportive group experience.

Once your application is approved, you can complete your payment below.

Deposit $1000. Full: $4800 private / $3800 shared.
Early bird: $4500 private / $3500 shared (before July 31, 2026).

Please enter your agreed amount at checkout.

Online payments (credit/debit card of PayPal) include a 4% processing fee (e.g $100 deposit = $1040). Venmo has a processing fee of 2%. Bank transfer, check or cash are available without additional fees. International transfers may include additional bank fees depending on your provider.

All payments are non-refundable unless the retreat is canceled by us, in which case a full refund will be issued. In certain cases, payments may be transferable or credited toward a future offering, at our discretion. We strongly recommend booking changeable or refundable flights, as we are not responsible for travel-related costs or changes.

Please note: If Stripe doesn’t work for you, PayPal or Venmo are available upon request.

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