Soul Aligned Application Form

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

My pronouns are:

I am ready to join the SOUL ALIGNED :: MENTORING CIRCLE because....

The biggest challenge/block I am experiencing right now is....

My biggest wish is...:

What I will bring to the others in the group is:

What I hope to receive from the group is:

Please share any health issues you are currently dealing with (physical and/or mental) and/or treatment you are undergoing/receiving:

I agree to honour the confidentiality of what is shared by everyone in the sacred group space

Yes, I agree

No, I do not agree

I understand that this program is for educational and general purposes and are NOT intended to diagnose or treat any physical or mental illness or to be construed as legal, financial or medical advice.

Yes, I understand and will seek the relevant professional support where needed

No, I do not agree

I understand that once I have registered for the program the fee is non-refundable and non-transferable

Yes