Name
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First Name
Last Name
Email Address
*
City and Country You're Based In
*
For time-zone purposes.
I am sure that I can attend the live bi-weekly calls.
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Yes I can attend the live calls.
No I cannot attend the live calls.
I am in a financial position to make the monthly payments and will not need to withdraw from the course for financial reasons.
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Yes, I can definitely make the monthly payements.
I'm not sure if I can make the monthly payments and I should perhaps register at a different time.
What called you to join this experience?
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Feel free to answer in the way that feels most relevant to you.
What aspect of your personal growth is inviting you deeper right now?
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What are your gifts?
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Feel free to share any qualities, gifts, or expressions you wish. This isn't about being 'perfect' at something, this is about what you ENJOY bringing to the world, whether you've mastered it or are just starting to cultivate it.
What is your current experience with breathwork?
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Feel free to share your experience receiving breathwork and any experience you might have holding space.
What are you most interested in learning about Breathwork Facilitation?
(For example: the science, the practical technique, the spiritual aspect?)
Do you have any specific questions or topics you want to make sure are answered in your training?
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Are you currently experiencing any of the following?
Pregnant or recently gave birth
Severe Asthma
Anxiety
Depression
Taking any medication that alters brain chemistry, such as anti-anxiety, anti-depressant medications (list below if yes)
Seizures, history of seizures or other brain/neurological condition or disease
A mental health state that affects your ability to engage in intense physical and emotional release, and mental exploration.
Feel free to elaborate on any box you checked above.
Is there anything else you want to share before we start?
I honour your bravery in embarking on this exciting journey.
You’ll receive an email within 48 hours officially welcoming you into the experience!
-Victoria