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2019 Retreat with Free Dolphins Application

2019 Healing Retreat with Free Dolphins (Application for attendance)

Thank you for your willingness to help us make our Healing Retreats with Free Dolphins, the premiere experience on the planet.
In order to have an  AMAZING journey, we need a POD (a family) of like-minded, high-level, beautiful people so that we can make this experience the most life shifting for ALL involved.

Please put aside a few minutes to fill out this 'application' to make sure you are a fit for the retreat and the retreat is a fit for you.

About this application form...
~ The following information is strictly for the confidential use of facilitators only.
~ Please answer these questions fully to enable the facilitators to guide your retreat appropriately.
~ Disclosure of any physical/psychological history will not necessarily prevent you from undertaking this retreat.
~ This form is destroyed at the end of your retreat. If you choose not to attend or you are not selected this time around we will delete your application immediately
~ All fields are required, so please write 'no', 'none' or similar if not applicable.


Thank you in Advance and ALL information shared is held in strictest of confidence.
These retreats have been organized by Lou Corleto, a World Class facilitator who has held events all over the globe.
We encourage retreatants to value this opportunity and so we ask everyone to commit to participating as fully as possible in the schedule of the retreat and to stay for the whole duration.
2. If accepted are you prepared to either pay the investment in full or put down a non-refundable deposit to secure your space?
Being there are only 20 total spaces we ask for fully committed people only.
*This question is required.
3.  Are you are attending the retreat with a friend or family member?
If yes, please give their name and relation to you (friend, partner, spouse etc) 
(NOTE: each person needs to submit their own application)
*This question is required.
4. The next couple of questions are to support you in your process:
Are there any needs or limitations we need to be aware of?
*This question is required.
5. This retreat includes daily processing activities, such as breathwork, yoga etc.
Do you have any limitations which may affect your ability to participate?
*This question is required.
6.  Do you have any special needs that we should be aware of, for example, 'allergies' or health challenges/medical conditions? *This question is required.
7. How is your emotional and mental state, now and in the recent past? 

If you have any history of suicidal thoughts or actions, or any recent history of emotional turmoil, anxiety/panic attacks,
depression, addiction, etc., including taking any medications for psychiatric conditions, please tell us here.

All information here will be kept confidential and will be reviewed only by our facilitators. *This question is required.
8. How did you come to know about our Healing Retreat with free Dolphins?
-> Please select the all that apply *This question is required.
10. Contact info please *This question is required.
11. That's it!
Just click the 'submit' button below and you're done. We'll get back to you within 3 business days.
Thank you.