Awaken, Heal, Transform | Jax Healing Retreat | Bali
Below are various questions that will help us determine if you are ready to embark on this Healing Journey and if you and Rebecca align for this deep inner work.
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Email *
Name *
What is your date of birth? *
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What is your WhatsApp number?
Gender
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Is there anything, in particular, you would like to share with us in why you have chosen this retreat in particular? Is there anything you think we should be aware of in regards to your story, trauma or your calling to join? Please know- anything you share is with strict confidence and when on the retreat you are only encouraged to share what you feel comfortable with.
 
Please tick all that apply to you below.
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We are currently updating our calendar for 2024 to include three-night and four-day healing retreats. Kindly indicate your preferred month for these events. *
Which accommodation option would you prefer for your stay? Twin shared rooms are available, and you also have the choice to opt for a single room, albeit at double the cost.
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The food is fresh, organic vegan food made daily by local chefs.... it is important we keep the frequency of our food high for this work, so no meat or dairy. Please list below if you have any allergies and/or dietary requirements. 
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Payment plans: *
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Have you previously engaged in practices such as Breathwork, Meditation, Somatic Healing, Trance Healing, Kundalini Activation Transmissions, or other forms of Holistic Healing arts?
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What are you hoping to achieve or embody through healing? *
Are you currently doing any courses/ reading/  learning about self healing, energy work, spirituality and so on? *
Are you currently investing in yourself with healing, therapy or self-care? If yes, please detail *
Do you feel it is improving your overall health and wellbeing? *
What do you wish to change in your future? *
Are you ready to fully commit to your healing? *
Are you ready to willingly meet all aspects of yourself, painful aspects and all? *
Are you ready to dive deep into your being and show up for yourself through all aspects? *
Are you ready to choose the path that will create change and new beginnings? *
As pre-requisite we ask for you to attend two Kundalini Activation sessions before coming arriving with Rebecca. This is important as your body will begin to open its channels and be prepared for the level of healing and work we will be doing. Please initial if you agree to this.
I, the Participant, voluntarily participate in the Healing Immersions with Rebecca Jax and accept full responsibility for my own physical, mental, emotional and spiritual wellbeing. Initial if you agree below

To ensure a harmonious experience during our retreat, it's essential that you participate in a minimum of two Kundalini Activation sessions either in person or online prior to joining us. This will facilitate the alignment and opening of your energy channels within your body, creating a stronger connection to the retreat's frequency. This preparation will establish a solid foundation for the transformative work we'll engage in.

Securing your spot on the retreat involves a few steps:

Application Approval: Once your retreat application is approved, you'll be eligible to secure your space.

Deposit Payment: A deposit of 50% of the total cost is required within 48 hours of booking. Upon receiving this deposit, we will update your balance and issue a new invoice. This remaining balance must be settled no later than 120 days prior to the check-in date.

Invoices will be sent out on specific dates, and timely payment is essential to secure your booked dates:

The day of booking180 days before the check-in date 120 days before the check-in date

We want to ensure that any changes or cancellations are handled smoothly:

Changes and Cancellations: All requests for changes or cancellations must be provided in written form. We appreciate as much notice as possible for any change requests.

Refund Policy: The initial deposit is non-refundable regardless of cancellations.

Last-Minute Bookings: For bookings made within 60 days of the retreat start date, the full payment is required within 48 hours of booking confirmation. Please note that such bookings are non-refundable.

We value your understanding of these terms and conditions, which are designed to create a balanced and transformative retreat experience for all participants. Feel free to reach out if you have any questions or need further clarification.

Please initial if you agree-

Thank you for submitting your Healing Retreat application. We will be in touch soon.
With Love,

Rebecca
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