Booking and Assessment form【Pre-Program】

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Thank you for your interest in our programs by KaleidoForest. In order to facilitate the utmost unique and personalised program catered specifically to you, please tell us a little about yourself below.

Email *

Name (First & Last — and any nicknames) *

Address *

Date of Birth

Phone Number (or WhatsApp / other relevant ID) *

Gender

Male

Female

Nonbinary / Genderqueer

Program Dates

YYYY

Which program do you wish to attend?

One-day course

Half-day course

Other:

1) What’s your motivation for participating in this program?

2) Tell us about your stay in Yakushima. Please include:

- Dates
- Accommodation Name

- Other activities you have planned during your stay

3) Tell us a little about your current health condition. Feel free to touch on your mental, physical and/or spiritual health (e.g. diet, exercise, stress, lifestyle, sleep, etc.), as well as any other concerns you may have at this stage of your life.

4) What are your energy levels like at the moment?

If 100 is your best score, please indicate your current range.

5) What kind of expectations do you have for our programs and/or tours? Is there anything you are specifically keen on doing?

6) About food: Do you have any dietary restrictions or any specific requests?

7) Are there any other things about yourself that you think we should be aware of?

Thanks for taking the time to share these bits and details about yourself.

We look forward to meeting you ♪

Send me a copy of my responses.

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