Pagpapagaling ng Ugnayan - Healing Circle Application
Welcome, please complete with gentleness. Brief answers are encouraged at this time, as there will be space to say more during the circles. Everything shared here is confidential, and will only be seen by Emerald and Michelle.

Dates:   Mondays,  May 6, 13, 27 & June 3, 10, 17 and 24  6:30 to 8:30pm
Location: Collingwood Neighbourhood House 5288 Joyce-Collingwood Neighbourhood House, Vancouver

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Email *
Full Name *
Ethnic/Cultural Background *
Pronouns
Sexual Orientation
Date of Birth *
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Email address *
Mailing Address *
Phone Number *
Emergency Contact, and relationship to you *
Describe your availability and commitment level for attending all 7 sessions on Monday evenings. *
How did you hear about the Healing Circle? *
What brings you to this circle? *
How do you prioritize self-care and personal wellness in your daily life?
What emotional and mental supports are in your life? (family, friends, counsellor, body practice, spiritual practice, etc.)
What are your hopes and intentions for your own growth and healing throughout the duration of this program? What are your expectations from this group?
Can you share any insights or perspectives you hold regarding the process of decolonization and its relevance to your own life?
What would you need to feel safer to participate? Are there any specific preferences or concerns you have about the composition of the group?

What other information about you that would be helpful for us know.

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