Describe your experience with any healing modalities, personal development and consciousness exploration. No experience necessary!*

What is your intention in attending this retreat?*

The cost of this event is $1888 and we are offering a special discount ($222) and a referral bonus for signups. Would you like to hear about our financing options?
YesNo

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City*

State*

How did you hear about this retreat?
FriendInternet searchFacebookInstagramOther

Age*

Gender Identity*
FemaleMaleNon BinaryPrefer Not to Say

Emergency Contact Name*
(Someone who will not be at the retreat with you)

Emergency Contact Phone Number*

Occupation*

Accommodations Preference*

Choose your desired accommodations (you may select more than one option). You will be contacted regarding availability of your selection and to match you to the best room for your needs. Refer to room rates at the bottom of the retreat webpage.

Quartz Stone Shelter – Two double bedsBasalt Stone Shelter – Two double bedsGranite Stone Shelter – Two queen bedsPine the Cabin -Two double bedsJuniper Yurt – One double bed One twin bedCedar YurtHollyhock Yurt – One Queen bedSunflower Yurt – Two twin bedsThistle Yurt – One queenVan/Truck site oneVan/Truck site twoWalk-In Tent Site One – River ViewWalk-In Tent Site Two – TerracesWalk-In Tent Site Three – HillsideNot Sure Yet

I prefer rooming with...
Let us know if there are 1-3 people you would like to share a room / yurt / cabin with, and if you

What are you hoping to experience or learn during this retreat?

What benefits are you seeking from this experience?*

Do you have any reservations or concerns?*

Write as detailed as your wish. Please be candid and honest. This helps us know how to support you best.

Medical/Dietary Concerns* Please list all issues concerning allergies, significant injuries (current and past), medications you take, illnesses/diseases, dietary restrictions, etc.

Meals will include vegan and mostly organic/local. Gluten, dairy, and eggs are always optional. Please describe any specific dietary allergies or preferences so we can best accommodate.*

Are you Gluten-free? Do you eat eggs? Dairy?

Do you eat fish/seafood?

Do you eat Chicken, Beef or Bison?

Do you have any allergies? If so, do you require anti-allergic medication in case of exposure?*
Include any alergies to food, oils, perfumes, smudging smoke (Sage, palo santo, etc)

Are you or have you ever been treated for any kind of mental illness or disorder, including depression, bipolar disorder, schizophrenia, or other conditions not listed? If so, please describe in detail.*
The presence of these conditions does not exclude you from participation. All information will be held in strict confidentiality. This helps us know how to support you best.

If any, are these experiences active or in remission?*

What are your current active treatments (if any) including any current medications and dosages?*

Please note any physical limitations which might affect your ability to participate in some physical activities? *

Describe your stamina and fitness for walking or hiking. (Moderate hiking, yoga, and other physical activity is included in this retreat) *

Moderate physical activity is optional in these retreats, please let us know your ability to participate in these kinds of activities.

Transportation Let us know your transportation preference - or leave blank if not sure yet. Check all that apply. Shuttle will be for an extra fee.
Driving my own carWill rent a car at the airportI'm open to sharing my car (personal or rental)I would like to share a ride with someone

Instagram Handle
We use this to easily share with the group at the end of the retreat to keep in touch.

Facebook User Name/link
We use this to easily share with the group at the end of the retreat to keep in touch.

Would you like to join Maloca Sound & Wellness’s email list?
YesNo

Would you like to receive information about other yoga or meditation retreats in the future?
YesNo

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