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Holistic Parenting Mama & Child Retreat registration form
Dear Mama, thank you! We are so thrilled to have you join us!
Please fill out the necessary information so we can get in touch with you.

Important reminders:
Who can register: Mamas and Kids under 4 years old.
Upcoming retreats: (7 days, 6 nights)
Retreat location: Ubud, Bali. Detailed location will be communicated by email.
To secure your spot, you will be asked to pay a $500 USD deposit (non-refundable).
Upon receiving this registration form, we will send you the details for the deposit payment.
There are only 7 spots available. The minimum of 5 participants are required to run the retreat. Under 5 participants, the retreat will be posponed and the deposits refunded.

More information and questions: or WA: +6281339489056
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Email *
Which retreat week are you signing up for: *
Your full name (name and surname) *
Your whatsapp number (with the country code): *
Your full Facebook name: *
Your date of birth: *
Your child's name: *
Your child's date of birth: *
Where are you travelling from? *
Which country are you from? *
Your dietary restrictions/allergies *
Your child's dietary restrictions/allergies: *
Please tell us a few words about yourself, your child and why you are willing to participate in this retreat. *
How did you find out about the retreat? *
How would you like to pay your deposit ($500 USD + transfer fees): *
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