Retreat Application Form


Please fill out the form below to apply for a space on our Retreat Yourself get away in Kaiteriteri.  You must already be a member with us to come on retreat, so if you haven't filled out our membership form, please do that first here.

We will be reviewing each individual application and allocating places to people who have never been on retreat with us before in order to give as many people as possible the opportunity to join us.  However, if we do have additional spaces available then we will offer those out to previous retreat participants.

We look forward to seeing you there!

There is a cost of $250 per person to come on retreat which includes all meals (organic, vegetarian), shared accommodation, yoga classes, mindfulness instruction, art therapy classes, pool/facility access.  We are asking for a deposit of $100 to secure your space as our spaces are limited to only 12 participants.  Should your condition change, or you need to pull out for medical reasons we will refund your money immediately.

We have a limited number of spots and last minute drop outs are hard to fill. Please complete this form only if you are 100% committed to attending and participating.

Name *
We'd love to know more about you, your cancer experience, your job, your life. Whatever you think is important! This is our chance to get to know you a little better. :)
Do you have any mobility issues, balance issues, or activity restrictions? *
Are you currently undergoing any cancer treatment? *
Have you ever had a seizure *