Slide 1

Application for Retreat

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Where are you from originally? *

Where do you live currently? *

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When is your birthday? *

Are you? *

Do you have children? If yes, how many and what are their ages and gender - male / female? *

What do you do for work / career? Do you like what you do? Explain. *

Why do you want to come on this retreat? List here. *

What top 5 things would you most like to get out of attending this retreat? *

What are behaviors & or habits you would like to stop & get rid of? *

Have you ever been on a personal development / wellness retreat? If so, when & where? *

Do you currently have a daily breathwork practice? If not, are you often aware of your breath and do you know the extreme importance of the breath? Explain. *

Do you currently meditate daily? If so, for how long and how many times daily? If not, have you tried and do you want to? Explain *

Do you work out regularly? How often and for how long? What do you do for your workouts? *

Do you have any injuries? Body Pain? Health concerns? Health ailments? Past surgeries? Please explain all here *

Are you happy with your weight? If not, how much do you weigh now (approx) & what do you want to weigh? *

Do you currently have a specific morning / night routine? Explain what your mornings and nights look like (routines) *

Do you have any diet restrictions / food allergies? Yes or No? Explain here your typical diet: eating patterns, restrictions, & allergies. *

Do you have specific food preferences? Explain here. *

Do you eat meat? Beef? Chicken? Turkey? Fish? Explain here. *

Do you drink coffee? How much? Do you need to consume caffeine daily? Explain here your relationship to caffeine and your needs for it *

Do you smoke tobacco? Marijuana? If so, how often? Explain. *

Do you drink alcohol or wine? If so how often? Explain. *

Are you currently taking any medications? If so, what? *

Do you take supplements daily? List what you take. *

Anyone else you want to refer for this retreat? Who? *

Make a Payment Below

The retreat is 4 days & 3 nights in the Redlands / Homestead, FL on our own beautifully secluded, 5 acre property with large pool, BBQ, fire pit, 2,000 Sq Ft meditation / learning room, gorgeous grounds and lots more

Cost includes:

• All meals and all sleeping accommodations are included – everything is included
• All workouts – activities- food – supplies
• Awesome goodie bags
• 2 – Individual, Private Coaching Sessions w/ Jolie (1 before the retreat & 1 after)

I will award ONE 1/2 off Scholarship to a lucky winner out of the applicants

SUPER QUAINT & INDIVIDUALIZED
small group and magical synergy – under 18 spots available so don’t delay & sign up now 🙂

COST will be *

Retreat – $ 2,024.00
2 Payments of $1111.00 a month apart – $ 1,111.00

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