Registration Form

First name

Last name

Phone

Country of Residence

Birthday

Day

Month

Year

Which training would you like to join?

What is calling you toward this immersion at this time?

Have you previously experienced bodywork, somatic practices, or similar work? (If yes, please share a little about your experience)

We ask the following with care, to ensure this space is supportive for you and for the group.

Are you currently experiencing any physical injuries, chronic conditions, or pain we should be aware of?

Are you currently taking any medications? (You are welcome to share only what feels relevant)

Have you experienced periods of significant emotional or psychological difficulty in the past? (If yes, you may share as much or as little as you feel comfortable)

Is there anything about your mental or emotional wellbeing that you feel would be important for us to understand in order to support you safely?

This work can bring awareness to deeper layers of the body and emotional experience. How do you feel about meeting yourself in this way?

Please tick if you are willing

Are you willing to take responsibility for your own experience, while being held within a supported space?

Are you able to commit fully to the duration of the immersion?

Thank you for taking the time to share.We will be in touch soon to connect further.

This process is a first step — a way for us to meet you, before we meet in person.