Serpent Rising Retreat Sign-Up Form

Inner Child Healing & Kundalini Activation Workshop

Friday 26th September – Mixed-Gender | Limited Spaces

Please complete the form below to secure your place. Once submitted, you will receive a welcome email with payment details and preparation guidance.

Full Name

Email

Phone (WhatsApp preffered)

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Where are you located (City & Country)?

What drew you to the Serpent Rising retreat?

(A few sentences from your heart)

Do you have any experience with Kundalini, energy work, or inner child healing?

Yes

No

If yes, please share briefly:

Do you have any current health conditions, emotional challenges, or trauma you’re navigating?

(All answers are confidential and help us create a safe space)

Emergency Contact Name & Phone Number

🐍 Payment Info $1444 🐍

A $250 deposit is required to secure your place. Details will be emailed to you upon submission. Final payment is due by 9th September

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https://www.elodiefabre.com/terms-conditions https://www.elodiefabre.com/cancellation-policy

I agree to the terms & conditions of this retreat, including the cancellation policy states on the website