APPLICATION: Pranic Awakening Retreat
Please complete this 'health' form to allow us to access how best we can assist you during your breatharian transition. We Kindly ask you not to apply / submit it should you be unable to meet our prerequisite criteria below. Please stay assured that we make sure all your data are safe as we do not share any submitted information with any third party - however, we are unable to control the end part of Google forms security so if you have any concerns about this form, instead of submitting this form, please send us an email to with answers to the following required questions. Thank you.

In order to participate, you must be:
1. over 18 years old;
2. not expecting/pregnant or breast feeding;
3. mentally sound (no major mental disorder);
4. physically ready with no ongoing eating disorder;
5. physically healthy with no conditions preventing you from abstaining from medication for 4 days
Email address *
Name *
Full First and Family name
Age *
Country *
of origin or the place you reside most
Phone Number *
(with your country code please), ex +61 for Australia + 48 for Poland etc
Occupation *
Profession or what you do for a living
Gender *
To which retreat are you applying? *
Have you ever done the breatharian process before? *
Have you ever done the breatharian process before?i *
Have you got any illness? What is your state of health? *
Tell us a few words about your wellbeing
Do you suffer from any mental illness or disorder? *
List any eating disorders in the past or currently, any issues mental health/mind related.
Do you have any experience with fasting and detoxification? *
Why do you want to do the pranic initiation? *
1-3 reasons you are planning to join the retreat.
What is your goal from the retreat? *
List your desired outcome from participation
List any fears you may have or questions *
Have you got any concerns about the process? Is there anything you still need to know?
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