Soul Sessions - Registration form

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Registration Form

* Indicates required field

Select a Desired Experience *

Your Contact Information

Name *

First

Last

Preferred name *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Information

Emergency Contact *

First

Last

Relationship *

Email *

Phone Number *

We need a few bits of demographic information.

Body identity (Gender) *

Sexual identity (Orientation) *

Years of Seasoning (Age) *

Abundance perception (Income) *

Personal bliss/Partnership status (Marital status) *

Daily Bliss (Employment) *

Formal Education *

Some High School Completed High School Some College Associate's Degree Bachelor's Degree Master's Degree PhD Certifications (Reiki, Nia, Yoga, etc.)

Ancestral & Cultural Identity (Ethnicity) - How do you see/identify yourself based on your ancestry and cultures? *

So, this is really up to you. We trust you more than anyone to tell us who you are and how you see yourself. While we will eventually, we'll add the list of 150+ ethnicities and 350 federally recognized tribes, we think it's most important for you to name yourself in this moment. So, have at it.

Are you currently or have you ever been a parent? *

Yes No Kinda

Life Education *

I'm a survivor. I've got serious street smarts. I can fix just about anything. I can read people. I drink and I know things. I can talk my way out of or into anything. I know who I am. I seen some things and am not easily surprised.

Ancestral & Cultural Identity (Ethnicity) - How do others within your ancestral and cultural groups tend to identify you? *

Within most cultural groups, their are important clarifications related to identity. This is an opportunity to add that information if it feels relevant.

Ancestral & Cultural Identity (Ethnicity) - How do others outside of your ancestral and cultural groups tend to identify you? *

We want to know what the world outside of you and your community assumes about your ancestral and cultural identities. This helps us to learn a bit more about how the world engages with you.

Tell us more about your relationship with parenting. *

Now for the good stuff. Tell us more about you.

Do you currently have a regular meditation and/or prayer practice? *

Yes No Kinda

Do you currently have a regular movement or exercise practice? *

Yes No Kinda

Tell us more about your relationship with meditation and/or prayer. *

Tell us more about your relationship with movement and/or exercise. *

What was the last thing that made you laugh? *

What was the last thing that made you cry? *

What are you feeling nervous about? *

What has you feeling optimistic? *

What parts of life/love/leadership feel unstable? *

What is something you really want? *

What parts of life/love/leadership feel steady? *

What is something you really, really want? *

What do you hope to experience during the sessions? *

What else do you want us to know about you? How do you want to be seen? *

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