Welcome

Retreat in Kinglake, 1 - 3 August 2025

Please complete the below form by the 15 July

Link to information on Spinal Energetics

Name

First Name

Last Name

Phone number

Emergency contact

Please provide name and contact information

Catering

All meals will be provided. Catered meals will be vegetarian. Please provide information on any dietary requirements for catering. Teas will be provided and coffee pods are available in the accommodation. Breakfast will be the provision of bread, spreads and cereals. Please indicate below if you require GF bread and/or milk alternatives (soy, oat, almond)?

Cold Pressed Juice

You will be provided with a cold pressed juice. Please indicate your preference.

Dinner beverage

We will gather for a communal meal on Saturday evening. Some wine and non-alcoholic beverages will be provided. Please indicate your likely preference.

Yoga Equipment

Yoga and meditation props can be provided. We will use these to support us in our Yoga and meditation practices. You will be asked to BYO blanket.

Please provide me with a Yoga mat

Please provide me with an eye pillow

Please provide me with a bolster

Your arrival time

Please let me know your estimated arrival time on Friday, if known

Optional Massage or Spinal Energetics Appointment

On-site massages are offered with local massage therapists for an additional cost of $100/50min. Payment to be made at time of the appointment. Limited on-site Spinal Energetics appointments are also available with Kirsty $100/45min. Payment to be made by bank transfer or cash at time of appointment. Please refer to retreat program when deciding on your appointment time. First in for appointment times. The list of available times will be updated as people book. Friday 1pm MASSAGE 2pm MASSAGE 3pm MASSAGE 4pm MASSAGE 5pm MASSAGE 2.45pm SPINAL ENERGETICS 3.30pm SPINAL ENERGETICS 4.15pm SPINAL ENERGETICS Saturday 9.15am MASSSAGE 10.15am MASSAGE 11.15am MASSAGE 12.15pm MASSAGE 1.15pm MASSAGE 2.15pm MASSAGE 11am SPINAL ENERGETICS 11.45am SPINAL ENERGETICS 12.30pm SPINAL ENERGETICS 1.15pm SPINAL ENERGETICS Please indicate your preferred time and service below

Song requests for Pohss Dance

We are lucky to have Soph from Pohss Studio facilitate an embodied dance and movement experience. You're invited to request 1 or 2 songs that will support you as you move, tune in and express yourself. Please provide song information below. This is optional.

Optional Activity Saturday afternoon

This activity is an additional optional add-on to the retreat weekend *It will only go ahead if there are a minimum of 4 people booked* The Matanya Effect in Kinglake offers a 2 hour equine energy workshop. This beautiful horse experience includes a discussion about how to monitor your energy and emotions, and time in the horse arena where you connect with and develop a relationship with your horse and the horse responds to your energy state through tasks and activities. This is not a horse riding activity. It is focused on mindfulness, emotional regulation, and self presence and awareness. **The cost is $170pp/2hours from 1-3pm on Saturday** Payment to be made directly with Matanya Effect on the day. Located a 5 minute drive from our retreat venue.

Yes, book me in

No, thank you

Your intention

You're invited to share a word or a few sentences about what energy (emotion/feeling) you hope to connect with or cultivate from this retreat

Injuries / Body Ailments

Please provide information on any relevant injuries or conditions which may impact your movement and Yoga practice (for example but not limited to: blood pressure, muscular, skeletal, pregnancy)

Public Liability

I understand I am fully responsible for my own body and I take personal responsibility to participate in a way which looks after my body

I consent to the use of magnesium salts, essential oils, coconut oil, sage and palo santo

I consent to hands on touch from the teacher to adjust postures and receive Reiki and energy healing

I consent to photography and videography throughout the retreat which may be shared on social media platforms

Any further comments