Application: Attachment Intensive Costa Rica 2026

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Application: Attachment Intensive Costa Rica 2026

Thank you for your interest in joining us. This form helps us ensure the retreat will be a safe and supportive space for everyone. All information you share here is kept strictly confidential and will only be used to help us support you during the retreat.

Email *

1. Name *

3. Accessibility Needs:

Please note: The retreat location is not wheelchair-accessible. Depending on where you’re staying at the retreat center, it may take you 10-15 minutes to walk to the session space on a somewhat long, somewhat steep hike. Walking from the Main Lodge (where we’ll have all of our meals) to our session space is, “The equivalent of climbing about 8 flights of stairs on uneven ground." If mobility is a concern, let us know so we can help you assess whether the space will be workable for you.

4. Background

How familiar are you with attachment theory?

Note: All familiarity levels are welcome - this simply helps us tailor the content to participants' needs.

I’m brand new to attachment theory

I’m familiar but still learning

I have an advanced understanding

5. Safety & Readiness

Please check to confirm:

I understand this retreat includes emotionally intensive group work and I can choose my level of participation in any exercise.

I understand this retreat is educational and experiential, and not a substitute for therapy or medical treatment.

I am NOT currently experiencing acute or severe symptoms that could affect my ability to safely participate in group work (e.g., hallucinations, paranoia, or active suicidal thoughts).

Required

Support & Safety

All questions below are optional and confidential. Sharing helps us better support you during the retreat, but you are not required to disclose any information you’re not comfortable sharing.

6. Current Support (Optional)
Do you currently work with a therapist, coach, or other mental health provider?

Yes, regularly

Yes, occasionally

No, not at this time

Clear selection

7. Mental Health Conditions (Optional)
Do you have any diagnosed mental health conditions you’d like us to be aware of?

Yes

Clear selection

If yes, please share any details you feel comfortable providing — this helps us better support you during the retreat.

Optional Reflection

What’s drawing you to this retreat right now?

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