EMBUDDHiMENT Coaching Intensive Application

Application Form.
  • Birth information is used to create Human Design Charts and Kundalini Numerology.
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  • Please list any known information about birth time. Example afternoon, morning, evening.
  • Please list the name and best phone number of your emergency contact.
  • Hello! Please take a few moments to tell me a bit about yourself and why you wish to take this coaching program.
  • Please list any prior trainings, areas of study, interests and information you feel is relevant to this program.
  • Please describe your occupation / workplace conditions.
  • Please list what days and times of the week are best suited for you to attend the zoom group sessions. (Example: Saturday Morning at 10:00 am MST.)
  • In order to care for each participant and shape practices to support overall health, PLEASE CHECK ALL THAT APPLY. Have you experienced in the past two years .. or .. are you experiencing now .. any of the following:
  • Please describe any current or chronic health challenges you are experiencing of a physical, mental or emotional nature. The more I know about what you are dealing with, the better I can shape your program.
  • Please list any medications and supplements you are taking.
  • Are you pregnant? IF YES: What is your due date?
  • Please check all that apply.
  • Please describe your exercise habits. Number of times per week | Types of exercise
  • Please describe your diet. Are you paleo, vegetarian, vegan, typical? Do you have any dietary restrictions (allergies / food sensitivities / core preferences)
  • Please describe your caffiene, alcohol, tobacco and recreational drug use habits. Are you willing and open to limit or refrain from the use of these substances during the coaching program? (Because of the nature of the practices, some substances can create significant challenge for the participant and are therefore dissuaded. Please feel open to chat with me about this.)
  • Is there anything else that you would LOVE to share? What makes you passionate about your evolution?
  • How do you wish to pay for the training?
  • By entering your name and date in the fields below, you are certifying that the information you have provided is complete and true to the best of your knowledge. You further acknowledge that the information will be held in confidence and used to optimize the training for each participant. You further acknowledge that once accepted to the training, your $525 deposit will be non-refundable.

Thank you for submitting your Application Intake Form. Please return to the Coaching Page and process your deposit. I will be in touch at my earliest opportunity.

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