ALCHEMY BY THE SEA

The Heart of Healing

Register Form

Nourish & Heal: Motherhood's Sacred Awakening

Sacred Journey of Self-Love, Regeneration & Immersion in Nature

New Moon Women’s Retreat | October 21st -25th, 2025 |

Tulum, Mexico.

EXCLUSIVE GATHERING FOR ONLY 6 WOMEN

This intimate and transformative New Moon Women’s Retreat is designed to guide mothers back to self-love and inner harmony. Your home during the retreat will be a private room in a secluded lush private villa nested the heart of the Mayan jungle, where the Caribbean Sea meets the sacred land of Sian Ka’an, a UNESCO World Heritage Site in Tulum, Mexico. This unique Eco-friendly property includes its own private Cenote with plenty of private space to connect with yourself and raw natural beauty surrounding you.

To complete your registration, please submit this form. After you complete this form you will receive a confirmation email letting you know your registration is complete.

Note: All information submitted is confidential.

Please send any questions and/or concerns to us at contact@alchemybythesea.com or tata.leban@gmail.com

First name

Last name

Phone

Date of birth

Month

Day

Year

City, State, Country

Passport Number

Do you have any mental or medical conditions that may be aggravated due to physical work or psychological stress? If yes, please provide details.

Have you had any embodiment/dance experience with Tata?

Yes

Have you worked with Dr. Di Toro?

Yes

Do you have any physical limitations that impact your mobility? If yes, please list.

Yes

Do you have travel insurance?

Yes

Travel Insurance Information

Please list a Local Emergency Contact including Name, Relationship, Phone number and Email address.

Medical Conditions (in case of emergency) - you do not need to disclose Yes

Yes

Your primary intention for joining this retreat?

What do you hope to gain from this experience?

Any special requests for room or other accommodation requests?

Would you like to be added to our future retreat mailing list?

Yes

Photo/Video Release: I grant permission for Alchemy by the Sea to capture photographs and videos of me during the retreat for use in marketing, promotional materials, and social media. I understand that these images may be used without compensation and th

I consent

I DO NOT consent

I understand that will send travel details including flight information once obtained

Cancellation & Refund Policy Acknowledgment

Our cancelation policy is clear and firm.

If traveling, we strongly recommend that you purchase a cancellation/travel insurance policy to protect your investment. My Trip.com or many other companies that offer a great deals.

Typically, trip insurance must be purchased at the same time you book your flight.

If you need to cancel your Retreat reservation for any reason - illness or emergency, you will receive a FULL REFUND minus a $200 processing fee. Please send your cancellation and refund request within 90 days of the retreat start date by email to tata.leban@gmail.com.

Cancellations made less than 90 days prior to the retreat will not be refunded.

I acknowledge the cancellation policy

Medical Waiver

This group experience is not intended to be a substitute for individual counseling or intensive psychological therapy. We do not provide medical diagnosis or treatment and the opinions and teachings provided in the workshop are not intended to be substituted as medical advice or constitute a psychotherapeutic relationship.

Although private meetings will be available with retreat facilitators, based on your needs, this is a group retreat, and our focus is to provide a therapeutic group setting to ensure the well-being of both individual participants and the well-being of the entire group.

As part of our registration process, we collect medical disclosure information from each participant. This, along with all of the registration information, will be held in confidence.

We kindly request that you disclose, with as much detail as possible, any relevant information concerning any known past or present physical, emotional, or mental health issue, injury or condition. If more information is requested, you may receive additional forms for completion based on your unique need(s). We will review this information as part of the registration process and offer recommendations and guidance prior to the retreat and accommodate you accordingly. Please let us know if you have any questions about your ability to participate in this experience.

Please note that if any participant requires intensive medical or psychiatric treatment during the retreat, staff may deem it necessary to seek off-site emergency medical care. First Aid medical care will be available onsite. Transportation will be available at the expense of participant should emergency medical care be required and there will be no refund issued for the remainder of the retreat.

I acknowledge the Medical Disclaimer above

In the case of an emergency, I acknowledge that I am responsible for my own health care costs.

Release of Liability

I understand that I will be responsible for my own well-being during the retreat. I will not hold Dr. Bernadette Di Toro, Tata Tamar Lebanidze and/or any other facilitator, assistants, practitioners or participants of this immersion legally responsible for any injury, illness, accident, or other misfortune that may occur in connection with my participation during this retreat taking place at the retreat center in Tulum, Mexico.

I attest that all of the information I have provided is correct and true. I am responsible for my own personal safety and wellbeing during the class. I will not hold the organizers or leaders of this series nor any of the other participants responsible for any act that is or may be detrimental to my person or health in whatever way. I acknowledge all the information I have given to be true and transparent.

I acknowledge the Liability Waiver above

Is there anything else you think we should know?

I agree to refrain from consuming mind altering drugs or alcohol throughout the duration of the retreat.

Please confirm that you have completely and honestly answered the health questions above.

Yes

ROOMS AND PRICES Eco-friendly accommodations. All rooms are unique except for the Treehouse 2 & 3 are identical. Rooms may be shared if desired by guests. Only 6 rooms available in total and private rooms are recommended to * *Only 6 Private Rooms avai