KAP & Yoga Retreat Form

HEART's REBIRTH RETREAT - MEXICO

40 mins to Mexico city from 1-7th February 2025 - Visit ahleph.com for more information
How did you hear about us? *
Full name*

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Date of Birth*

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Address*

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Emergency contact*

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What is your motivation behind joining this retreat?*
Why would you like to attend the KAP & Sound Retreat?*

Relax and take sometime outTransform and do deeper inner work and let go of the pastFind my true self and my purpose in lifeTo meet new peopleGo deeper in my Kundalini Activation energy to expand my consciousness.Learn to how to create a life I always dreamed of.
Tell us about yourself.
Health Details

In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential.

Please answer the health related questions below*

	Yes	No
Do you have or have you ever had any physical health problems, eg. diabetes, epilepsy, high blood pressure and cardiovascular?*
Do you have or have you ever had severe any mental health problems, eg: bipolar disporder, psychosis, Schizophrenia, PTSD?*
Are you now taking any prescribed medication?*
Are you now taking any of the following drugs: barbiturates, amphetamines, cocaine, heroin, hallucinogens?*
Do you have muscle or joint problem that could worsen by a change in your physical activity?*
Do you smoke?*

If you answered "Yes" to any of the questions above, give details of all occurrences. Include the following: dates, frequency, type, amount etc below
Do you have any dietary requirements?
* We only serve plant based , GF meals prepared by our in house chef. This retreat is strictly meat and alcohol free. We kindly ask all participants to respect our space and avoid bringing or consuming any animal product, alcohol to the retreat.
Have you attended KAP (Kundalini Activation Process) class in the past ? Please specify how many classes and name of the KAP facilitator*
Preferred sleeping arrangement (All prices are in USD)*

Twin Share bedroom (Early Bird offer end 30th Nov) ($2,440 per person)

Heart's Rebirth Retreat - Mexico (1-7th Feb 2025)

Heart's Rebirth Retreat - Mexico 50% Deposit (Early Bird) - Twin Share bedroom 7 x Days accommodation, all meals and workshops are included

$1.220,00 Quantity
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HEART's REBIRTH RETREAT - MEXICO