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Retreat Application – Roxy
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Email *
Which retreat are you applying for?  *
Full name
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Gender
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Date of birth (for legal clarity)
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Where are you from?  *
What is your occupation?  *
Do you have any experience with Tantra, Yoga, or similar practices?
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How would you describe your sexual experience so far?
Please share a few sentences about your level of experience, comfort, and what you’re currently exploring.
What are you hoping to get out of this retreat?
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How did you find me, and how long have you been following my work?
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In your own words, what does “consent” mean to you?
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In your own words, what does “mindful” or “mindfulness” mean to you?
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Is there anything else you would like me to know?
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Safety, Boundaries & Consent

This retreat includes emotional, mindful and tantric practices.
To maintain a safe and respectful environment for everyone, participants must agree to the following:

• You agree to respect all retreat rules around boundaries, consent, emotional safety and confidentiality.
• You understand that you participate voluntarily and take full responsibility for your physical and emotional limits.
• You will inform the facilitator of any medical, psychological or physical conditions that may affect your participation.
• You agree not to film, record or photograph any other participant without explicit permission.
• You understand that the practices offered are not medical or psychological treatment.

Your agreement is required in order to join this retreat.

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I would like to receive updates about future retreats, workshops or online programs.
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