Kamp Kaya Booking Application
Kaya Wellness in an INCLUSIVE community and designed to support womxn who are on a healing journey. Kaya Wellness does not discriminate against race, age, sexuality, ability, color, religion, political party or ability. 

I'm exited you feel Kaya Wellness is the right next best step for you and thrilled to get to know you better. In an effort to do so please fill out the form below.  


Please be on the lookout for a call from a (318) number, it will be me, Kelly. Let's connect and get you on your way to building your self healing community. 
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Email *
Name *
First and last name
Date of Birth *
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Email *
Phone number *
Address *
Emergency Contact Name and Phone Number *
Which Room are you interest in? *
Required
Do you have any food allergies *
If yes please fill us in
How do you care for yourself when you are hurting *
Required
What healing steps have you already taken *
Required
What inspired you to join a Kaya Wellness Retreat *
What are you hoping to gain from attending a Kaya Wellness Retreat *
Are there any parts of you that are worried about attending a Kaya Wellness Retreat? *
Do you have any mental, emotional or physical concerns that would prevent you from participating in any Kaya Wellness Retreat events? *
When is the best time to reach you for our call? Please provide 2 day and time options?  *
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