5 Elements Registration Application
Thank you for applying for these very special detoxification retreats with Laurel & Andy.
Some of the elements of the retreat have medication & health condition considerations, please fill out each question and if any issues are raised we will get straight back to you.
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Please nominate an emergency contact: Name, telephone number and your relationship to this person
Are you taking any prescription medications or herbal or vitamin supplements?
Yes (please list in the next section)
Medications & supplement list (if applicable)
General Health: Please list any health conditions or issues here
Why are you interested in attending this retreat?
We are offering Purification Sweatlodge (Lakota Native American Style) ceremony(s) as part of this retreat.
This will be my first experience
I have experienced a Sweatlodge ceremony in the past
DIET: The 5 Elements retreat is designed as a cellular cleanse based on naturopathic principles. Please nominate the level of dietary detoxification programme that interests you. Note: the final day is a plant-based Phase Out, and we also have specific teas, and other naturopathic/herbal processes throughout the detox. PLEASE CHOOSE THE LEVEL OF YOUR CLEANSE
Strong Cleanse: Organic vegetable juice fasting on arrival (2.5L)to Phase Out on afternoon of final day (total 4 days of 2.5L per day)
Medium Cleanse: Organic vegetable juice fasting (2L per day) , add hot soup/broth each evening
All 5 Elements participants will receive a complimentary naturopathic consultation (phone, zoom or in person) prior to the retreat so that every aspect of your health is considered during the retreat. Please tick all that apply to you
Food cravings, for example: carbohydrates, bread, chocolate, sugar
Daily caffeine intake (includes green tea/matcha)
Marihuana intake every week (or more often)
Alcohol intake every week (or more often)
COLONIC HYDROTHERAPY: A safe and efficient treatment to rid the colon of built up wastes and enhances the totality of the cleanse. This retreat requires 2 sessions with option for third (time permitting and at an extra charge). Some health conditions may contraindicate you for this treatment.
I do not have colon cancer, or history of bowel surgery
I have not been diagnosed with Diverticulitis or any inflammatory bowel condition
I'm not sure about having a colonic session at all, I'll take the alternative herbal approach
Here's an overview of therapies & group events included in 5 Elements Retreat
Ka huna bodywork 1.5hrs x 2
Morning yoga 1.5hrs x 4
Sauna (far infrared ) we suggest 2 x 25-min sessions per day
Morning ritual of herbal teas & gut cleansers
Colonic hydrotherapy sessions, 2 x 1hr sessions
Self directed Art Therapies for emotional wellness
Diet: 2 levels of organic vegetable juice fasting regimens
Take home pack including DIY cleansing information & recipes
Sound healing ceremony with ceremonial tobacco
Cacao Ceremony & sound healing on final evening
Group Breathwork Ceremony daily
Daily check personal check in/out with team
Purification Sweatlodge on arrival, and at completion
Deposit: 50% deposit to required to book your space Cancellation policy: deposit is 100% refundable if your retreat is impacted by Covid-19 restrictions OR if you cancel/change your mind anytime up to 30-days before retreat commencement ONLY, after this date any monies paid become non-refundable if you cancel/change your mind. Final payment due 21-days prior to retreat start date.
I've read & understand the cancellation policy
I'm interested in booking in for the following retreat, and will pay my deposit on acceptance:
Monday November 1st, 11am arrival - 4.30pm Friday 5th
Monday January 10th, 11am arrival - 4.30pm Friday 14th
Monday March 14th , 11am arrival - 4.30pm Friday 18th
I'm not ready to join a retreat just yet, please keep me informed via Heart Breath Awakening mailing list
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