Atlachinolli 3-day Ceremonial-Immersive Retreat
Hello! And thank you for your interest in this transformative retreat.
This is a pre-reservation form. Once you submit it with your answers, you will receive an invoice and payment details.
Your retreat spot will be held for 48 hours after we send the payment details.
Pepem, and your retreat guides, are looking forward to sharing this experience with you!
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Email *
Growing Beyond My Roots
Full Name (preferred and for invoicing purposes) *
Date Of Birth *
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Your Best Email *
Your Best Telephone Number *
Address (for invoicing purposes) *
Your top 2 emergency contacts (Name and number) *
Do you have any food allergies?
Do you have any specific dietary requirements? (e.g vegan)
Do you suffer from any health or medical conditions?
Are there any challenges you are experiencing in your life right now? 
What do you most want to take away from this retreat experience?
What interests you most about this retreat? (Ancient Rituals food, meditation, connection, escape, healing Movement, sound, etc)
*
Do you intend to travel with a friend or partner?
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Do you have a friend or partner you would like to share with who wold also benefit from this experience? Please leave their details below if you would like us to reach out to them?
 If you have any other questions or requests please provide them below and we will be sure to answer them as soon as possible.
A $500 deposit will secure your place today, No refundable from april the 5th. Please indicate below if you would like to reserve your spot
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TERMS AND CONDITIONS:                                                Strict Cancellation Policy:  If cancelled within 3 weeks of the retreat, 40% of full amount of retreat will be refunded. If cancelled within 72hrs of the retreat, 25% of retreat amount will be refunded.                                                           Public liability Insurance: Public Liability Insurance is not covered by ‘Surfing Butterfly ‘The Atlachinolli Retreat'. We suggest all individuals who choose to stay and participate in the activities and experiences at ‘The Atlachinolli Retreat’  to purchase individual travel insurance that includes medical coverage and COVID-19 cancellation insurance. If insurance is not purchased and cancellation due to Covid 19 is inevitable, 48 hours prior de event,  50% of the retreat fees will be transferred to the following retreat or atlachinolli events.                                                                                        By proceeding with the booking, you are acknowledging that you understand and fully accept all potential risks in traveling to and from the venue, and potential risks involved in the activities and experiences that are offered at ‘Atlachinolli retreat’. These risks include, but are not limited to, injury, sickness, or any other threat of physical harm and damage to or theft of personal property.  There may be a great variety of other risks not known or reasonably foreseeable. ‘The Atlachinolli Retreat’ is not responsible for any loss or harm that might occur during the retreat. You are also agreeing to fully release and discharge ‘The Atlachinolli Retreat’ and ‘Avalon Cottages’ and its owners, directors, employees, officers, facilitators, guides, guests and agents from all claims for damages or liabilities that may occur as a result of participation in ‘The Atlachinolli Retreat’, including but not limited to injury, illness, emotional damage, travel expenses, property damages as a result of unexpected occurrences including those from weather, local political situations, wildlife or uncontrollable acts of God, including the risk of death. For the benefit of everyone at the retreat, ‘Atlachinolli Retreat’ reserves the right to accept or reject any participant at any time without liability, and in the event, it determines, in its sole and exclusive discretion, that a participant is disruptive to the harmony of the retreat, it may without any obligation to pay a refund or any other amount.                           ‘The Atlachinolli Retreat’ will carry no responsibility or liability for any participant who leaves the retreat prior to its conclusion or for any activity undertaken by any participant, which is not included on the retreat.         ‘The Atlachinolli Retreat’ is committed to bring a safe environment and show care for each individual. *
Remember your space is not confirmed until the deposit payment fee is done. Your spot will be held for 48hours after sending you confirmation and payment details.
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