QC26 Bali Retreat - Attendee Details

1. Identity

Use the name on your passport.

Primary attendee's name

Who you're sharing the room with.

Required

Full legal name (as on passport)

Required

Preferred name

Valid email required

Phone (with country code)

Required

Date of birth

Required

Country of citizenship

Required

T-shirt size

For your retreat welcome pack.

Required

2. Postal Address

For pre-retreat materials.

Address line 1

Address line 2

City / suburb

State / region

Postcode

Country

3. Emergency Contact

In case anything happens during the retreat.

Name

Phone (with country code)

Relationship

4. Medical & Health Screening

Critical for safe participation in the physical and breathwork sessions. Shared only with the retreat team.

Are you currently taking any medications?

Yes No

Required

List your current medications

Are you taking any of the following?

Tick all that apply. These specifically interact with breathwork and cardiovascular load.

SSRIs / antidepressants Mood stabilisers Anti-anxiety medication Blood pressure medication Beta blockers Heart medication Other psychoactive medication None of the above

Tick at least one

Pregnancy / postpartum status

Yes, currently pregnant Yes, postpartum within 6 months No Not applicable

Required

Are you currently working with a mental health professional?

Yes No Prefer not to say

Anything else medical we should know? Recent injuries, undiagnosed concerns, things in passing.

6. Breathwork & Trauma Work

We run four trauma-release breathwork sessions during the week.

Previous breathwork experience

None 1-2 sessions Occasional practice Regular practice

Required

Previous trauma-release or somatic therapy work?

Yes No

Required

Brief description (modality, duration, anything we should know)

Current meditation or breath practice

None Occasional Daily

7. Movement & Fitness

Current fitness level

Sedentary Moderate Active Very active

Required

Any current physical injuries or movement limitations

8. Travel & Logistics

Any accessibility needs or preferences

Mobility, sensory, room setup, or anything else we should plan for.

9. Intentions

Sets the tone for your week. The team reads every one of these.

What are your intentions for QC26?

Required

Anything else you'd like the team to know?

10. Partner / Room-share

Are you bringing someone to share your room?

Bringing a partner or sharing your room with another attendee?

Yes No

Required

Partner / co-attendee first name

Required

Partner / co-attendee email

They will receive a unique partner-ticket payment link at this email.

Valid email required

11. Consents & Acknowledgements

I have disclosed all relevant medical conditions to the best of my knowledge

Required

I understand this information will be shared only with the QC retreat facilitators

Required

I consent to participate in all retreat activities at my own risk

Required

Photo / video consent

Yes, full consent No Specific opt-outs (note below)

Required

Specific opt-outs

Something went wrong. Please try again, or email admin@quantumclub.com.au if it persists.

Congratulations. Your QC26 spot is locked in.

1. Identity

2. Postal Address

3. Emergency Contact

4. Medical & Health Screening

5. Lifestyle & Diets

6. Breathwork & Trauma Work

7. Movement & Fitness

8. Travel & Logistics

9. Intentions

10. Partner / Room-share

11. Consents & Acknowledgements

All set.