Retreat Intake Form

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Intake for Couples Retreats

Once you have decided to join a retreat, please sit down together and fill in this form. This form is only seen by your main facilitators, Shashi and Shane, and all information shared remains confidential. It helps us to know which areas to cover to serve your needs.

Couples Retreat Intake Form

Which retreat(s) do you wish to attend (you can apply for multiple retreat with one form) *

October 4th - 11th: The Seven Veils of Intimacy

* Indicates required field

Partner 1

Name 1 *

First

Last

Partner 2

Name 2 *

First

Last

Gender *

Email 1 (main email) *

Experience in Tantra *

None Read/ watched videos Joined a few classes/ retreats Very experienced

Gender *

Email 2 *

Experience in Tantra *

None Read/ watched videos Joined a few classes/ retreats Very experienced

Dietary Requirements *

Vegetarian Gluten-free Dairy-free

Other *

Dietary Requirements *

Vegetarian Gluten-free Dairy-free

Other *

Answer these together:

Relationship status *

Married Living Together Dating Monogamous Dating Polyamorous Other

Other: *

How long have you been together? *

Areas of Interest (tick all that apply) *

Increase physical intimacy Feel more sexually attracted Explore new methods of sexual connection Heal from past trauma Improve emotional maturity Improve communication skills Heal escalating conflict cycles Repair from betrayal Meet each other on a new level Awaken the energy body/ Kundalini Expand spiritually together Other (specify)

Other: *

What would be your ideal outcome after this retreat? *

Do either of you have any fears, resistances or apprehensions about this retreat? *

I agree to receiving marketing and promotional materials

Submit

Home
Group Retreats
- Retreats 2024
- Week Long Retreats 2024
Private Retreats
Online Events
About