Retreat Registration Form
27 - 29 January,
Terra Raíz

Hello and warm greetings.

Thank you for your interest in our Breathwork & Yoga Transformational Retreat!

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Location:  Terra Raíz

Terra Raíz

Retreat center is located just an hour's drive from Lisbon Airport at: R. DO NORTE 18, CASAL DA CHARNECA, ALCOBAÇA, LEIRIA (airport transfer available)


Check in:  between 3pm and 4pm

Check out: 5 pm

You can choose following rooms:

Terra (private single suite) 1 double bed - 635€* - NOT AVAILABLE

Fogo (private double loft) 1 double bed and 2 single beds in mezzanine - 1170€ for two people*   - NOT AVAILABLE

Ar (shared loft) 1 double bed, 2 single beds in mezzanine - 520€ per person*

Água - (shared Apartment) 1 double bed and 2 single beds in mezzanine, support kitchen -  520€ per person*

Bungalow NAMASTE 3 SINGLE BEDS -  520€ per person*

 *the price includes the retreat program, accommodation, food, snacks, drinks  

You will be entitled to a certificate of participation "Activate Your Truth"

Check out the rooms:


The application is an essential part of your healing journey and we believe it begins the moment you submit your application to us. The application process will help you to clarify your intentions and give you an opportunity to share more about what you hope to receive from this retreat.

Please know everything you share here is private and confidential. Please feel free to share openly.

Shortly after submitting your application, you’ll receive an email notification of next steps. If you do not receive the confirmation, or have any questions regarding the retreat or application, please contact us at: or Joanna +436764320080 / Claudia +351919496790

We look forward to getting to know you better!

Your trainers:
Full Name: *
Email Address: *
Phone Number or WhatsApp: include area code *
Where do you live? And what is your Nationality?
Date of Birth:
What is your gender?
How did you hear about this retreat?
Have you done transformational breathwork and/or rebirthing before? If yes, please specify.
Have you ever done yoga before?
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What are your intentions / goals for participating in this retreat?
Do you have any physical ailments or other limitations? If so, what are they?
Do you have any food allergies or dietary restrictions? Please specify.
What are the top 3 things you are looking forward to about this retreat?
Do you have a regular mindfulness practice? Please tell us about it.
Due to the powerful healing nature of breathwork, we ask participants to avoid alcohol or drugs during the retreat. Do you agree to this?
Please tell us about any issues, past or current challenges that you would like to overcome during the retreat?
Emergency Contact (Name / Relationship / Phone / Email)
Do you have any questions for us?
The Agreement Field: 
In order to create a powerful healing container, it is important to have energetic agreements. I acknowledge that this retreat is: 
1) A sacred space and will treat it as such. 
2) It is a safe space, not a space for judgment of myself or others. I will listen with an open heart. 
3) It is a confidential space. 
4) I acknowledge this work can be challenging and I agree to stay through it so I can see what’s available to me on the other side. 
5) I agree to withhold from giving advice unless specifically requested, instead I will witness and reflect. 
6) If I have a concern or complaint about the circle, I will bring it with love to Joanna or Claudia. 
7) I agree to have FUN, get CURIOUS and ENJOY the journey!
Price Breakdown

Regular price: €520-635€ (depending on the room you choose)

Including food and accommodation.

Once my participation is confirmed, I understand that a 25% non-refundable deposit is needed to hold my space. Remaining balance is due on or before January 17, 2022. There are no refunds after January 17th. I will be sent instructions by email of how to submit my deposit via bank transfer or Stripe.


We recommend you take travel insurance covering for personal effects, personal accident, medical and emergency travel expenses, as well as cancellation and curtailment.

Trip insurance can protect your retreat investment if you need to cancel for covered circumstances. Due to resort's refund policies, we cannot offer any refunds, transfers or credits for cancellations for any reason (including legitimate ones like illness, injury, family deaths or emergencies) within 30 days of the retreat start date. No refunds or credits for failure to attend or failure to complete the retreat. Please Note: Travel Insurance and gratuities for staff are not included in the registration fee.

Thank you! We will be in touch!
Please confirm. *
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