Registration Form - Retreats (Detailed)

Dear Sister,
Welcome to DanzaMedicina!

Thank you for giving this great step towards YOU, remembering the beauty of the ancient ways! Thank you for allowing yourself to reconnect with your body and reawaken your womb wisdom, honoring your life cycles and relationships throughout your sacred womanhood.

Please, read carefully our Term of Acceptance.

It is very important for us to have all the answers completed. Thanks for your time and attention and feel always free to enter in contact for any questions, requirements or demanding- We are here to help and support you!

Workshop City and Date

Name

First Name

Last Name

Email Address

Age/ Date of birth

Nationality

Which languages can you understand clearly?

Occupation

How did you learn about DanzaMedicina and this workshop?

E-mail, Facebook, Instagram, friends?

Do you have any previous experience with meditation techniques, dance or healing practices?

If yes,please describe:

Do you have any physical health problems or medical conditions?

If yes, please describe.

Have you ever had any surgery and/or fracture? Have you ever been hospitalized?

If yes, please describe.

Are you pregnant? If yes, how many weeks? Do you have any complications? If yes, please explain.

If yes, please describe.

Do you exercise regularly? How fit are you to do physical activities?

Do you have any CV condition (high blood pressure, history of heart problems, heart attack, myocarditis, atrial fibrillation, aneurysm, stroke, others)?

If yes, please describe.

Do you have a history of convulsion (epilepsy or others)?

If yes, please describe.

Do you have a history of glaucoma associated to high intraocular pressure?

If yes, please describe.

Do you have a history of asthma or bronchitis? How often do you experience attacks that require a rescue inhaler?

If yes, please describe.

Do you currently have or have ever had any significant mental/emotional condition (depression, anxiety disorder, bipolar disorder, schizophrenia)? Are you currently on or have you ever been on any prescription treatme

If yes, please describe.

Are you currently on or have you ever been on any type of medication?

If yes, please describe.

Do you currently use or have you ever used any illegal substances? Do you have any addictions?

Drugs, tobacco, medications, alcohol...

What are your main areas of interest that drove you to this workshop? What do you wish to achieve with this workshop?

Please enter your emergency contact details

Full name, email address, relationship, and phone number

Would you like to add anything to information above?

We respect you privacy, all informations are confidential.

Queremos te conhecer!

DanzaMedicina

Registration Form - Retreats (Detailed)

Dear Sister, Welcome to DanzaMedicina!

Dear Sister,
Welcome to DanzaMedicina!