Embodied Anatomy Workshop Intake Form Page

Embodied Anatomy Workshop Intake & Payment Form

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Name

First

Last

Telephone

(include country code)

E-mail

Date of Birth

DD/MM/YYYY

Age

Workshop/Retreat you are registering for:

Please choose the workshop/retreat for which you are registering

Briefly Describe Your Dance Background:

Briefly Your Joining

Primary Objective for Joining this Workshop/Retreat:

Is there anything about your physical health, past injuries, or accessibility needs that you'd like me to know to support your experience

Have You Attended a Workshops/Retreat Before?

How Did You Hear About This Workshop/Retreat?

Consent and Policies

Electronic Signature

By typing my name above, I confirm that the information provided is accurate and I agree to the terms of this intake form.