BlissDance SPAIN Retreat ~ Participant Information & Consent Form (T&C) 
BlissDance Immersion Dates:
  • 7 nights, 8 days
  • Thursday 25 April - Thursday 2 May 2024

Venue: Hidden Paradise


BlissDance is a profound Tantric Movement Practice of Awakening: awakening in us our universal desire for Truth, Presence, Love, Connection, Beauty, Freedom, and Pleasure!

BlissDance, like Tantra, supports the powerful integration of all seeming polarities such as the sacred, profane and the sexual; the light and the shadow; and the masculine and the feminine. 

Please complete this application form before you proceed to payment.

Sign in to Google to save your progress. Learn more
Email *
PLEASE TAKE YOUR TIME TO COMPLETE THIS FORM as it will be of great support in enabling us to co-create a powerful and rich experience for ALL of us.  We really appreciate your care & consideration.

With great-hearted Love, 
Kali, Rhianne & Stephen
Full Name *
Nationality / Country and City of residence / Age *


Option 1:
➺ Single: 1 person -  $2,094 // ZAR39,970 (single rooms are limited to 5 and will be allocated on a first come first served basis)
*Note: Single Accommodation is FULLY BOOKED

Option 2: ➺ Shared:  2 people - $1,932 // ZAR36,880

Option 3: ➺ Dorm: 3 - 6 people - $1,824 // ZAR34,820

  • You are welcome to do a one-time payment for your retreat fees. Please email for payment link/banking details 
  • Alternatively,  please email us at to arrange a payment plan. You're welcome pay in consecutive monthly instalments. Let us know your needs and we will arrange the appropriate payment links for you.
  • All retreat fees are to be paid in full by 1 April 2024.
Are you part of the BlissDance Level 1 Year 1 Training?
What accommodation are you booking?
Are planning on attending ALONE or with a partner / friend?
If you're attending with a partner / friend, please provide their full name & email address
Which payment option will you use?

1. Proceed to Payment >>HERE<<

2. EFT - South African Payment
Bank: Standard Bank
Account type: Current 
Account Holder: Shakti Shiva Academy (PTY) LTD 
Account Number: 0000010196276940
Branch Code: 051001  
Proof of Payment:

How or where did you hear about this retreat* *
Do you have any experience with BlissDance? *
What is your experience with other movement or dance modalities? (conscious dance, movement medicine, Biodanza, 5rythms, ecstatic dance, etc.) *
What is your previous experience with personal growth work? (i.e. Trauma Healing, Somatic Experiencing, breathwork, bodywork, yoga, sexuality, spirituality, conscious dance, meditation, tantra) *
What is your understanding / experience of Tantra? *
What is your motivation to participate in this retreat?* *
What would you like to gain from this retreat experience & what are your expectations? *
HEALTH CONDITION: This Retreat is not a substitute for medical or psychotherapeutic care. Please take note that the nature of the BlissDance retreat content is potentially transformational and may trigger past traumas that remain unresolved and/or could evoke uncomfortable feelings.  

Please speak to your mental health practitioner, if you are consulting with one, about whether this retreat is appropriate for you at this time. Should you have a history of sexual trauma or other related issues and are therefore concerned about the potential impact of the retreat on yourself,  it is your responsibility to contact the retreat organiser & facilitator prior to the start of the retreat.  

If you, the participant are currently undergoing any kind of treatment (especially psychiatric or psychological), you undertake to inform the organiser & facilitator about this fact and also the nature of challenges/ difficulties you are experiencing before starting the retreat. 

You, the participant, also undertakes to inform the organiser & facilitator about any possible health complications (post-traumatic conditions, long-term illnesses, epilepsy, asthma, etc.)  

Do you agree?
RESPONSIBILITY: Participation in this BlissDance retreat is for adults only and is entirely voluntary. By registering for this retreat you agree to take full responsibility for your mental health and well-being for the duration of the retreat. You, the participant agree to hold full responsibility for your experience, for yourself and for everything that you do (or do not do) throughout the entire retreat program. The facilitator(s) and/or organiser(s) instructions are only suggestions by which you, the participant, are guided solely at your own discretion.  

Do you agree?

I understand that the facilitators and/or organisers do not dispense medical advice or prescribe the use of any technique as a replacement for treatment of physical, mental, or medical matters by my doctor/therapist either directly or indirectly.  I take full responsibility for any consequence resulting from my participation in all session(s).

Do you agree?


I am aware of the risks and dangers involved in gathering together on retreat in these times of Covid-19.  I am prepared to be exposed to these risks and dangers and to the possibility of illness and/or death and will take part in the activities of my own free will.

Do you agree?


I acknowledge and undertake that I have no claim against the facilitators, the organisers, contractors, or the owner of the Venue on account of death or personal injury or the loss or damage to any personal belongings arising from any cause whatsoever and indemnify and hold the facilitators, the organisers, contractors, or the owners of the Venue harmless against any such claim, demand, or liability.

Do you agree?


All meals are included. The food is all fresh, local, seasonal, super nutritious and incredibly delicious! It’s all vegetarian, and they’ll cater for your dietary requirements (vegan/gluten-free etc.)

If you require a VEGAN diet or have any other special dietary requirements, please write your clear and complete request here. 

We will endeavour to meet your reasonable requirements and will contact you directly should we require any clarity. 

* Cancellation up to and inc. 31 January 2024: All payments (less your non-refundable deposit) will be refunded to you
* Cancellation up to and inc. 29 February 2024: 75% of your payments (less your non-refundable deposit) will be refunded to you
* Cancellation up to and inc. 31 March 2024: 50% of your payments (less your non-refundable deposit) will be refunded to you
* Should you cancel after 31 March 2024, no refund will be due to you and you will forfeit any and all payments made.                                                                                                                                                 
Do you agree?
NON-OBSERVANCE OF THE AGREEMENTS: In the event of non-observance of the agreements, inappropriate behaviour on the retreat or on the venue premises, the facilitator and/or the organiser reserves the right to ask the participant to leave the retreat. From the beginning of the retreat, during the retreat and after the end of the retreat there is no claim for the facilitation fee to be refunded. Any or all claims for refunds on food and/or accommodation fees are also waived. 

Do you agree? 
By submitting this information form & paying the retreat fee, you express your agreement and consent with these terms and conditions of participation. 

Do you agree?
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy