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Worksheet

Book 'Couples Reconnect' group retreat in Bali, in August, 2027 with Chalisa Morrison...

Please fill out the form below to register your interest in booking 'Couples Reconnect' group retreat in Bali, August, 2027 with Chalisa Morrison.

I offer a limited number of group couples retreats each year  - know that I do read each inquiry 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. ➜

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

10. ➜

Please tick that you understand:

11. ➜

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. 

 

12. ➜

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

13. ➜

Which style of group retreat are you most interested in?

14. ➜

for Bali retreat, are you available in August 2027?

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

15. ➜

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

16. ➜

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

17. ➜

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

18. ➜

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):


19. ➜

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

20. ➜

Are you a student, unemployed or on sickness leave?

21. ➜

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

22. ➜

What is your preferred way to be contacted?

23. ➜

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