ROOT + ROSE application form

This application is for me to get a feel for how this retreat can support you into your fullness, this retreat is a space to go deep + my desire is to ensure that you receive the most potent of experiences that enables you to go back into your life inspired, grounded + open to your next chapter.
Please answer all questions honestly + openly, it is less about how far along your path you are + more about the essence of you I am curious about.

Name

First Name

Last Name

What has called you to this retreat?

Where are you on your journey with embodiment? Have you a relationship to your body already, do you have an understanding of your nervous system at presence?

Which retreat option are you applying for?

Non Residential (£550)

Residential Private Double with Shared Bathroom (£675)

Residential Shared Twin Room with Shared Bathroom (£615)

Part of the Medicine of this Retreat is being in connection with other Women, are you ready to be in a space where you are involved in connection and communication with the rest of the group? Please note this retreat is not for anyone who is wanting to keep themselves to themselves for the whole retreat, there will be space for alone time through the weekend but the Medicine we are cultivating here is rooted in connection to ourselves + other Women.

Yes

What is your current relationship like to your body + listening to her Wisdom? Do you have a relationship to your Womb space?

Is there anything about your health you feel I should know about? Do you have any allergies or dietary requirements?

Do you have any of the following: Schizophrenia, Bipolar, Epilepsy, current narcotic addiction or are you pregnant?

What personal intention do you have for the retreat weekend? Having this information prior to beginning gives me opportunity to curate the retreat in a way that supports the women joining.

How would you like to pay?

Deposit option - £200 non refundable deposit with remaining payment due by 10th June

Pay in full option

Monthly Payment Plan - final payment is due by the end of July 2025