Registration Form

First name

Last name

Phone (WhatsApp)

Please include your country code

Country of Residence

Birthday

Day

Month

Year

Which training would you like to join?

Please write the name of the course and the course dates.

Application Form Introduction

This application is received by Molecular Earth as part of a living enquiry into a container of support, relationship, and embodied communication.

The questions are not designed to judge, diagnose, or measure you.

They are here to open a first conversation - to sense whether this course series feels supportive, timely, and appropriate.

Molecular Earth is not held as one person alone, but as a wider field of practice:

a relationship between body, ground, nervous system, community, and the more-than-human intelligence of life.

Your responses will help Molecular Earth understand what brings you here, what kind of support you may need, and whether this series is the right container at this time.

Please share a short introduction about yourself.

You’re welcome to share anything that feels relevant - who you are, what’s present in your life, or what’s bringing you here. You may include a short introduction within your answer below if that feels more fitting.

1) What brings you to this work at this point in your life?

2) What are you hoping this experience might support or shift for you?

3) What are your current practices relating to support, sustainability and awareness?

4) Have you experienced Contact Improvisation, bodywork, somatic practices? ...something else? (If yes, please share a little about your experience)

The following questions are taken with great care, to ensure this space is supportive for you and for the group.

1) When things feel overwhelming, how do you tend to respond?

2) What helps you return to a sense of ground, stability or steadiness?

3) Is there anything currently happening in your life (physically, emotionally, psychologically) that may impact your capacity to be in a group or embodied process?

Molecular Earth is not asking for details as such, only what feels relevant to share.

4) How comfortable are you with expressing boundaries or saying no in real time?

5) Are you open to moments of not knowing, slowing down, or not being “good” at something?

Yes

6) What does support mean to you?

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

8) Are you currently taking any medications?

9) Have you experienced periods of significant emotional or psychological difficulty in the past? How is your relationship with it now?

10) Is there anything about your mental or emotional wellbeing that you feel would be important for The Molecular Earth to understand?

11) What's your understanding of conscious ways of being?

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

13) Is there anything else you would like to share; including any questions, concerns, or uncertainties?

14) Are you able to commit fully to the duration of the selected immersion/s'?

Yes

Would like to talk about this?

✧ For those wishing to join ✧

10-day Molecular Earthing Bodywork Training Only

as a standalone, please respond to the following three questions.

These questions help Molecular Earth understand your relationship to touch, awareness, and relational work, and support a first sense of whether this training is the right step at this time.

Following this, a short conversation may be arranged to explore alignment and answer any questions.

1) What experience do you have with bodywork, touch-based practices, or embodied relational work? (If none, please share any relevant experience of working with the body, awareness, or close human interaction.)

2) During your Bodywork Practice, when you place your hands on another person, what guides you?

3) How do you (or how would you) recognise when to stop, slow down, or change what you are doing when working with someone?

Please tick if you are willing

I take responsibility for my own participation, including my pace, needs, boundaries, and limits within the supported space.

I agree to practise clear, ongoing consent, and understand that I can say no, pause, or step out at any time — as can others.

I understand that occasional media may be captured, and I can opt out or adjust my consent at any time.

I understand that this training is not therapy, psychotherapy, or medical treatment, and does not replace professional support where needed.

I understand that Molecular Earth may pause or adjust participation if needed to support the safety and integrity of the group.

Thank you for taking the time to share so honestly.

Your interest, care, and attention are received with gratitude. This form is not a final decision, but a first point of contact — a way for Molecular Earth to begin sensing whether this work feels supportive, timely, and appropriate for you.

These agreements exist so the work can stay clear, respectful, and real.

Molecular Earth looks forward to reading your responses and connecting with you further.

From here, there may be an invitation to meet for a short conversation before any place is confirmed.

Thank you again for your time, your dedication, and again your interest in this work.