Spirit Babies - Healing Womb Grief June 2018

Thu 14 Jun 2018 to Sunday, June 17, 2018

Thank you so much for your interest in our weekend immersion - Spirit Babies - Healing Womb Grief.

Please take a moment to fill in the Registration Form below. All of your information remains Private and Confidential and will not be shared forward.

Much love Kate and Sharon xxx

Registration Form

* Required Fields

First Name *

Last Name *

Email *

Mobile *

Country

Street Address *

Suburb *

State *

Post Code / Zip *

Date of Birth *

Occupation *

Next of Kin: Name and contact number *

Are you allergic to any food or have any food preferences, eg, vegetarian, vegan, gluten free, dairy free, raw food etc. *

Do you have any current medical conditions that we should know about that could impact your ability to participate in this weekend (physical or mental)? Please include full details. *

Have you ever had a drug/alcohol dependency or addiction? *

Yes

If YES, please give full details if this is a current or past issue.

Have you had any mental issues or are currently dealing with mental issues (psychosis, schizophrenia, severe depression, severe anxiety etc)? *

Yes

If YES, please give full details if this is a current or past issue.

Are you dealing with severe trauma or have been treated for trauma in the past? *

Yes

If YES, please give full details if this is a current or past issue.

Please take some time to tell us your story and what is calling you to attend this Workshop. *

Are you willing to take full responsibility for your health and safety, over the weekend? *

Yes

Would prefer a King Single Room or Twin Share? *

How did you hear about this Retreat? Please enter Promotional Code or Referral Affiliate if applicable. *