Healing Body Project

Participant Information Sheet

Thank you for completing this participant information sheet. We require this information to ensure your physical and mental safety during the course. Your information is strictly confidential and not shared with any third parties. We strictly adhere to our Privacy Policy which can be downloaded from the link at the bottom of our website healingbodyproject.com

Name *

Email *

Phone *

Date of birth *

Address

Street Address *

City *

State *

Country *

Postal code *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *

How did you hear about Healing Body Project? *

To ensure your safety and wellbeing, and that of other participants and facilitators at Healing Body Project, please answer the following:

Are you currently pregnant? *

Yes

Do you currently have any injuries or physical medical conditions? *

Yes

Do you currently have any formal mental health diagnoses or other conditions? *

Yes

Is there anything else you would like Healing Body Project to know about? *