Personal Information
Name
*
Where is your current home base?
*
Email
*
Phone Number
*
Format: (000) 000-0000.
Who is your emergency contact? Name and phone number
*
PERSONAL HISTORY & INTENTIONS
What is your intention for joining The Dojo Woman Collective in person immersion?
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Have you done group work IN PERSON with women before? If so, please tell us more about those experience(s). ie. What is your relationship to sisterhood? What type of personal practice and sisterhood practices most resonate or have not resonated for you?
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What excites & ignites you most about receiving this experience with Zahara, Naia and The Women of The Collective? Be expressed about your highest excitements and desires!
In which areas of life are you experiencing edge(s) that you wish to receive support around?
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Are you currently taking medication for any psychiatric disorder?
Yes
No
Prefer not to share
If yes, please share more about your trauma history and what those medications are / dosage so we can be aware and in highest service?
*
Are you currently struggling with any PHYSICAL health symptoms that we should be aware of? (Please include food allergies)
Is there anything else you would love for us to know before entering into this experience together?
Signature (I affirm that all above is represented in full truth)
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