Welcome to The Chakra Immersion!
Hey, guess what?!

WE'RE GOING TO COSTA RICA BABY!!!

But before we do, please take the time to fill out this form so we can best prepare for our time together.

Please answer the questions honestly. This will help us best show up for you during the Chakra Immersion. Your answers are safe with us and will only be seen by Kinley and the Chakra Immersion Team. 

This is created for Wom(b)en of every size, every color, and every belief system! Must be 18+.

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Email *
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By clicking I AGREE, we (you and Kinley Lane) are both agreeing to honor and protect the information shared here. Do you agree to fill out this application honestly? Please know this is a judgment-free zone. You are safe here. I love you. *
Name (First and Last) *
Your answer
Phone Number *
Your answer
Instagram Profile Name
Your answer
What has brought you here?
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Your answer
Have you traveled internationally before?
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Required
Have you participated in any of Kinley's offerings?

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Required
Do you have any previous experience with yoga or living a yogic lifestyle? 

*You do not need ANY experience in yoga to participate in this Immersion.* 
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Your answer
Why do you desire to join the Chakra Immersion?

Please explain your intention for diving into your chakras on this immersion. Your intention can be focused on healing, awakening, or celebrating.

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Your answer
Do you have a medical history we should be aware of? 
Examples: high blood pressure, heart problems, epilepsy, seizures, and/or diabetes.

If yes, please explain so we can best hold space for you on the immersion.
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Your answer
Do you have any allergies? If so, please list them. 

*When you fill out this form, you are agreeing to bring any resources needed for your travels. (Example: EpiPen, Benadryl, etc.)
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Your answer
Do you have any dietary restrictions? 

*Vegan, vegetarian, dairy-free, GF, etc.
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Your answer
Would you prefer vegetarian, chicken, or beef for your arrival meal? (it is most likely a burrito bowl sort of dish)
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Your answer
Are you pregnant or plan to become pregnant before the immersion?
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Your answer
Do you promise to abstain from drugs and cigarettes while on the immersion?
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Your answer
Because of the power behind The Chakra Immersion, Kinley will be adding a 1-hour Zoom call one month before we leave, to help prepare for the experience.

This additional coaching call will help the group prepare and connect with each other. There will also be a special WhatsApp group created for this container. 

Are you willing to download the WhatsApp app and be on the coaching call? 

This FREE additional coaching opportunity is not required but highly suggested as we enter into this sacred container together. YAY for freebies and additional support! 

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Would you like to attend the International Chakra Immersion in Costa Rica?

March 15th - March 22nd, 2025


All Lodging, Food, and Activities are covered during your stay at our 5-star, privately gated home. 

Schedule: (more details to come)
Saturday: Arrive In Costa Rica, then shuttle to the retreat home and rest.

Sunday: 1st Chakra Yoga + Local Cooking Class

Monday: 2nd Chakra Yoga + Heated Rivers Exploration

Tuesday: 3rd Chakra Yoga + Ziplining 

Wednesday: 4th Chakra Yoga + Cacao Tour & Ceremony

Thursday: 5th+6th Chakra Yoga + Hanging Cloud Bridges

Friday: 7th Chakra Yoga + Spa Day in the Volcanic Heated Pools + Volcanic Mud Massage

Saturday: Pack up and travel home

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Are you willing and able to do all the excursions?

Therapeutic Yoga 

Local Cooking Class

Heated Rivers Exploration

Ziplining 

Cacao Tour

Hanging Cloud Bridges

Spa Day in the Volcanic Heated Pools 

Volcanic Mud Massages

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Your answer
Are you willing to purchase your flights to and from Costa Rica from wherever you are located? 

We monitor flight prices to get the best deal, and we will always share when we see lower prices!

Everything else is covered in the cost of the Immersion!

- All transportation, including to and from the airport
- Air-conditioned room 
- All meals included!
- Zip lining through the Rainforest Canopy of Costa Rica!
- A spa day in the naturally heated spas!
- A private volcanic mud massage!
- Daily chakra yoga and meditations! 
- A day in the clouds on the famous Hanging Bridges! 
- Cultural cooking class from a local!
- A local cacao tour!
- Meditating in the naturally heated volcanic river!
- One whole week of immersion healing in Costa Rica!

...AND SO MUCH MORE!!!

**You will need to bring personal money for souvenirs and extra purchases (energy drinks, snacks, etc.). We provide water bottles, fresh fruit, and up to $20 a meal. If you decide you want more, it is your responsibility to pay the difference. Alcohol is not included.


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Are you fully committed to paying an energetic exchange for this life-changing experience? 

**Please read below**


**$3,797 - $4,997 will be paid to Kinley's Lane for the five-star private property, all transportation in Costa Rica, Lodging for seven nights and eight days, all meals, therapeutic chakra yoga classes, DAILY excursions, somatic embodiment practices, a one-month prep call with Kinley Lane prior to the Immersion, a Whatsapp community including all participants, and soul-searching activities at the private retreat location. If accepted, you will receive a link to purchase your ticket and lock in your spot.

IMPORTANT: If you sign up within the first week of the Immersion's enrollment opening, you will receive $500 OFF the price below!

Ticket Price
$4,997: Private Queen Room w/ AC

$4,497: Shared Room Twin Bed, w/ AC 

$4,297: BFF Shared King Bed, w/ AC 


Pictures and videos of the rooms can be found on the website!

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Which payment option do you prefer?

*If you choose a payment plan, a multi-payment fee will be applied to cover processing costs. It is around $100, depending on your room choice.
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What room do you prefer?
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If you chose the BFF Shared Bed, what is the name of your friend with whom you plan to share the bed? 

*They are also required to fill out an application.*
Your answer

Please check any symptoms or experiences that you have had in the last month.

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Required
What does support look like when you are struggling or processing heavy emotions?  *
Your answer
Emergency Contact Name and Phone Number *
Your answer
If accepted, are you willing to pay within 24 hours of your "application acceptance" email?

A deposit is required to claim your room. We will hold it for up to 24 hours, and if a payment is not received within that time frame, we will open your room up to the next interested applicant.

*A reminder email will be sent out before we open your room to other applicants.
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Is there anything else you feel Kinley needs to know before traveling internationally for a week on this Chakra Immersion? *
Your answer
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