DONNA WALSH RISE

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application for bali retreat

This application helps us determine if you’re ready for this journey and if you, Donna and facilitators align for this level of deep inner work.

Name *

First Name

Last Name

Email *

Phone *

What is your WhatsApp number?

Country

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Your Story *

Tell me why you feel called to this retreat. What would you like us to know about your story, your trauma, or what brought you here? You are only ever invited to share what feels safe and comfortable, both now and while on retreat.

Gender

Medical History *

Please thick all that apply below.

Pregnancy

Actively using recreational drugs

Uncontrolled thyroid health issues

Epilepsy

Severe PTSD

Kidney Disease

Diabetes

Severe Asthma

History of Seizures

High Blood Pressure

Detached Retina

Cardiovascular disease, previous heart attck or stroke

Prior diagnosis of bipolar disorder, schizophrenia or previous psychiatric condition

Diagnosis of aneurysm in the brain or abdomen

Hospitalisation for any psychiatric condition or emotional crisis within the last 10 years

Current alcoholism addiction

Suicidal Ideation

None of the above

2025 Healing Retreat Dates *

Which Accomidation option would you prefer for your stay? *

Twin shared rooms are available, and you also have the choice to opt for a single room, albeit at double the cost.

Are you ready to take control of your Journey?

Meals And Dietary Requirements

All meals are fresh, organic and plant-based, prepared daily by our local chefs. Please note: While we are plant-based by default, you will have the option to request additional protein (such as chicken, steak or fish) when we collect your detailed dietary preferences closer to retreat. Please list any allergies or specific dietary requirements below:

Payment plan *

Pay in Full

Pay in Two

Have you previously engaged in practices such as Breathwork, Meditation, Somatic Healing, Kundalini Activation Transmission, or other forms of Holistic Healing Arts? *

What are you hoping to achieve or embody through healing? *

Are you currently investing in yourself with healing, therapy or self-care? i *

if yes, please detail

What do you wish to change in your future? *

Are you ready to dive deep into your being and show up for yourself through all aspects?

I, the Participant, voluntarily participate in the Healing Immersion with Donna Walsh Rise Retreat and accept full responses

I, the Participant, voluntarily participate in the Healing Immersion with Donna Walsh Rise Retreat and accept full responsibility for my own physical, mental, emotional and spiritual wellbeing. Initial if you agree below.

Thank you!

I am so proud of you for taking this first step, For Yourself !

I see you, I hear you, I am here to guide & nurture as you RISE.

I look forward to holing a container for your healing journey.

Your healing starts within

Love & Light

Donna x

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