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Worksheet

Book 'Couples Reconnect' group retreat in Bali 2-9th August, 2025 with Chalisa Morrison...

Please fill out the form below to register your interest in booking 'Couples Reconnect' group retreat in Bali 2-9th August, 2025 with Chalisa Morrison.

I offer a limited number of group couples etreats each year  - know that I do read each application carefully, and I personally reply to everyone who takes the time to complete my online form.

Please know that your privacy is important to me and I will treat your confidential information with great care and respect.

Thanks for your patience and I look forward to supporting you.

Kindness and respect,

Chalisa


1. ➜

Date

2. ➜

Name

3. ➜

Email

4. ➜

Phone

5. ➜

Please tick whether you are applying as an individual or couple

6. ➜

Partner's name - if applying as couple

7. ➜

Partner's email - if applying as couple

8. ➜

Just confirming: Are you looking for a private personalised retreat OR a group couples retreat?

9. ➜

Please tick that you understand:

10. ➜

What kind of retreat are you looking for?

Everyone has different retreat needs and preferences

-> my Bali 'Couples Reconnect Retreat' has 4 hours of group sessions a day with the afternoon free for participants to chill at the 5 star resort or enjoy Bali's culture. 

 

11. ➜

Tick the relevant areas that best match what you are looking for:

12. ➜

Which style of group retreat are you most interested in?

13. ➜

for Bali retreat, are you available in August 2025?

Please advise any preferences for retreat dates - retreats usually start on a Friday or Saturday and run for 7 nights.

14. ➜

Please describe your top 5 challenges that you're currently experiencing:

15. ➜

If you were to work with Chalisa during a transformaitonal retreat, what would be an amazing outcome?

16. ➜

Have you completed any of Chalisa's online 'Love Me Up' programs?

17. ➜

Have you previously worked with Chalisa in private 1:1 sessions?

If you have previously worked with Chalisa, please advise: when you worked with me, approximately how many sessions and briefly what was most beneficial to you (or your relationship):


18. ➜

If you have ticked 'yes' above, please tick which online programs you have completed / started:

19. ➜

Are you a student, unemployed or on sickness leave?

20. ➜

Is their anything else you want to say or want me to know?

21. ➜

What is your preferred way to be contacted?

22. ➜

We would love to hear about how you heard about Chalisa and her work (if you can spare the time)