WCC Questionnaire

Women’s Courage Circle Questionnaire


[contact-form][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Date of Birth’ type=’text’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Address’ type=’text’ required=’1’/][contact-field label=’Phone(s)’ type=’text’/][contact-field label=’Contact in case of emergency’ type=’text’/][contact-field label=’The Women’s Courage Circle touches the soul of who we are. In order for me to hold safe and sacred space for your journey%26#x002c; it is important that I have this information about you. If any additional information comes up as you fill out this form%26#x002c; or if you need more space to answer these questions%26#x002c; please use another page.’ type=’text’/][contact-field label=’1. What draws you to this process at this time in your life? ‘ type=’textarea’/][contact-field label=’2. What do you know about your calling?’ type=’textarea’/][contact-field label=’3. Do you have a spiritual practice? If so, please describe:’ type=’textarea’/][contact-field label=’4. How would you describe your relationship to personal growth?’ type=’textarea’/][contact-field label=’5. How would you describe your relationship with nature?’ type=’textarea’/][contact-field label=’6. How would you describe your relationship with ritual?’ type=’textarea’/][contact-field label=’7. Are you currently, or have you been on any medication? If so, please describe: Do you have any medical conditions that might affect your participation?’ type=’textarea’/][contact-field label=’8. A beautiful meal is included in the retreat for those who register on line at least one week before the Circle. The food service at EarthRise Center is a varied buffet. Lunches are protein-rich vegetarian. Please indicate if you eat: Vegan, No dairy,No wheat/gluten’ type=’textarea’/][contact-field label=’Please list any other allergies: If you are on a special or very restrictive diet you may need to bring some or all of your own food and prepare it in the community kitchen. Space can also be made in the refrigerator for your food. I look forward to meeting with you on October 20th at 10 am.’ type=’text’/][/contact-form]

Translate »