Kerry Magnus Client Portal

Retreat Application

Thank you for taking the time to complete this form.

Personal Details & Getting to Know You:

Retreat Application

This field is for validation purposes and should be left unchanged.

Full Name

First Last

Email address

Age

Country of residence

Where did you hear about this retreat?

What is calling you to register for this retreat?

What other programs or experiences have you participated in for personal growth or transformation?

Do you have any dietary requirements or food allergies?

Do you have a history of trauma and have you received support for your trauma?

Do you have any medical conditions we should be aware of, or are you currently under the care of a mental health practitioner?

Yes

Do you have any history of sexual or other trauma that you would like Kerry to be aware of, so that she can hold this in gentle awareness when holding space for you?

Yes

Is there anything else you feel we should know, or that you would like to share?

• I understand that I will receive from this retreat what I am willing to put into it.
• I take full responsibility for my own transformational journey.
• I am committed to my self-care and have the capacity to seek external support for my healing process if needed.
• I respect the intimacy and confidentiality of this retreat container and will not publicly share what is shared by others during the retreat.
• I understand that although Kerry Magnus is a qualified psychologist, she will not be acting in that capacity during this retreat.
Her role is that of guide and facilitator.
• I am committed to honoring my financial investment in full.
• I understand that retreat payments are non-refundable.
• I agree to all of the above terms and policies.

Signature

If you are currently receiving treatment for, or have a history of, mental health challenges, please ensure that you share this with us so we can provide appropriate support and ensure this retreat is the right fit for you.

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I understand that I can unsubscribe at any time.

Retreat Application

Personal Details & Getting to Know You:

Retreat Application

Still have questions? We are ready to support you.

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