Soulful Retreat Booking Form Name(Required) First Last Email(Required) Phone(Required)Emergency contact name(Required) First Last Emergency contact email(Required) Emergency contact phone(Required)YOUR RETREATRoom preference:(Required)Twin share room with shared bathroom $2,500 ppDeluxe King Room with ensuite: $3,500 pp (single in king bed)Deluxe King Room with ensuite: $2,900 pp (twin in shared king bed – cannot be split)We have two stunning, fully contained dwellings for our guests – The House and the The Villa.The House is home to a maximum of 4 guests and The Villa is home to a maximum of 10 guests. Each dwelling has a Deluxe King Suite with ensuite upstairs and twin share rooms with shared bathrooms down stairs. Deluxe rooms are priced for single occupancy in a king bed OR as twin occupancy for friends only (shared bed – cannot be split). All rooms are spectacular, however hosts will allocate your rooms based on first bookings allocated to the best rooms.Have you been on a retreat before?YesNoHave you practiced yoga before?(Required)Yes – many timesYes – a few timesYes – only restorative or yinNo, neverWe will have 45-60minute yoga practices. Beginners welcome.Have you meditated before?Yes – regularlyYes – infrequentlyNo, neverGuided meditation practices will be sprinkled throughout our journey as an invitation to drop in to your own heart.What's your intention for your time on retreat?What are you hoping to experience on your retreat? Whether it’s rest, healing, inspiration or connection, we’d love to know.PHYSICAL HEALTHDo you have a chronic medical condition we should know about? Please list:Do you have a medical condition that might impact on your ability to participate in yoga, Body Mind Flow fitness sessions or other movements practices? Please list:Please list any dietary needs, restrictions or allergies. This includes any foods you don't like. Amanda, our cook will cater accordingly. We want you to have an amazing experience with the food so please list anything you think of that will impact on that.(Required)Have you been exposed to hot/cold therapy?(Required)SaunaCold plungeBothNoneWe have a sauna and cold plunge. These are optional but there are some contraindications to using them.Do you have any of the following? Blood vessel problems such as Raynaud’s Cryoglobulinemia Paroxysmal cold hemoglobinuria (PCH) Cold urticaria Epilepsy Venous stasis dermatitis Peripheral Neuropathy If you have heart, blood pressure or circulatory issues seek medical advice to determine your safety to participate. None Contraindications for cold exposure like an ice bath or cold plunge.Do you have any of the following? Low blood pressure or orthostatic hypotension Dermatitis Deep vein thrombosis Chronic heart failure or other heart conditions Peripheral vascular disease Pregnant Diabetes Contraindications for hot exposure like a sauna and spa.Have you had recent surgery or illness or are you expecting to prior to retreat? Please describe below.List any medications you take and the reason for taking them.Do you live with chronic pain or injury? Please describe:Sleep hygiene(Required) I snore I use a CPAP machine None of these, that I am aware of Please tick if you’re aware of any of the following:REBIRTHING BREATHWORKThere are some contraindications to participating in Rebirthing Breathwork.Have you done Rebirthing Breathwork before?(Required)YesNo, but I have heard of itNo, and I have never heard of itYou will experience a Rebirthing Breathwork session. It is deep dive with the breath as a gateway into the deeper, more sacred layers of Self by conscious connected breathing through the nose.Do you have a mental illness? Please describe belowDo you have any of the following?(Required)VertigoEpilepsyBipolar disorderSchizophreniaNonePregnancyI am pregnantI am planning on being pregnanyNo I'm notTERMS AND CONDITIONSI understand I am responsible for getting myself to and from the retreat including flights and transfers, or self driving. I understand I need to provide Mel and Tanya with details about my travel arrangements by emailing info@bodymindflow.com.au(Required) Yes I understand I understand my investment includes a $500 non refundable deposit. If I cannot attend, I forfeit this deposit, unless a full paying replacement guest can take my spot. In which case I will be refunded, less a $100 administration fee.(Required) Yes I understand I have read the Welcome Pack brochure including the payment policy, cancellation and refund policy.(Required) Yes I have and agree to the T+Cs I understand I am required to organise my own travel insurance.(Required) Yes I understand I understand the balance is payable by the 14th August 2025 and I can pay this as a lump sum, or in instalments. If paying in instalments, I will email info@bodymindflow.com.au each time I make payment stating the date and amount transferred.(Required) Yes I understand PHOTOGRAPHYI understand that photos and videos will be taken and shared by the hosts (Body Mind Flow, Mel Omar and Tanya Savva) for the purposes of social media, websites and future marketing material. If I do not agree, I will contact them directly to discuss.(Required) Yes I understand and agree to this T+C
