a sacred pause

The Sacred Restoration Retreat Application

This application is an invitation to pause, reflect, and feel into whether this private retreat container is aligned for you. Please answer honestly and from the heart. There are no perfect answers.

Full Name *

Email Address *

Phone Number *

City and State *

What is calling you to The Sacred Restoration Retreat at this time? *

What are you currently moving through emotionally, spiritually, mentally, or physically? *

What patterns, beliefs, identities, or experiences are you ready to dissolve?

What does authentic reconnection mean to you?

Have you worked with energy healing, cacao, sound healing, spiritual cleansing, or plant-based ceremony before?

Do you have any physical, emotional, or medical considerations Cynthia should be aware of?

Do you have any medical concerns, allergies, or dietary restrictions (food, environmental, medication, or other) Cynthia should be aware of? *

Are you currently under the care of a therapist, doctor, or mental health professional?

What support do you feel you need most right now?

Are you available for May 29th to June 1st, or are you interested in future dates? *

Are you prepared for the investment of $1,555 if approved? *

Would you prefer to pay in full or use the two-payment option? *

I understand that the deposit is refundable within 48 hours and partially refundable afterward, with $444 retained to honor preparation.

Is there anything else you would like Cynthia to know?