Birth information is used to create Human Design Charts and Kundalini Numerology.
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 training.
Please list any prior trainings, areas of study, interests and information you feel is relevant to this training.
Please describe your occupation / workplace conditions.
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.
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 vegetarian? vegan?
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 refrain from the use of these substances before and during the training?
(Because of the nature of the practices, these substances create significant challenge for the participant and are therefore dissuaded.)
Is there anything else that you would LOVE to share?
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 $570 deposit will be non-refundable, except in the case of event cancellation.