Application form and Consent
Dear participants of the Maya Mandala seminars, we want to remind you once again that the transmitted practices lead us to the original state of consciousness, during which there is a deep transformation of energy flows at all levels: at the level of the body, emotions and mind.
We ask you to be very careful and attentive to yourself when you practice, connecting with the quality of presence, awareness and responsibility for what you are doing.
First of all, a big request to inform Maya, as well as certified Mandala dance leaders, about your existing diseases that may limit your entry into the practice, namely: all mental illnesses, recent (less than 1 year) operations, cardiovascular diseases , spinal injuries, fractures of the pelvis and lower extremities, craniocerebral injuries. A special warning for those who have oncological diseases, since at the moment of practice the process of energy awakening takes place, at this moment all tensions and diseases are activated, and this is your personal deep process, for which you are fully responsible.

By participating in seminars, group or individual classes, you take responsibility for your condition at all levels (body, emotions, mind) before and during practice.

Maya, as well as the leaders and organizers of the seminars, reserve the right not to admit a participant to the seminar or to remove him from an already ongoing practice.

In order for us to be able to register you for the seminar and in the database, please fill in
I. QUESTIONNAIRE:
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1. E-mail *
1. Full name *
2. Date of Birth *
3. Phone *
4. City *
5. Your activity type *
6. Would you like to receive the newsletter? *
7. Did you provide a copy of the medical insurance (policy) for the duration of the seminar, valid for the region, country, city? (in the case of a retreat) *
8. Contact phone number, name and email of your relative or other close person who can be contacted in case of unusual situations with you: *
9. How did you hear about the seminar / master class? *
10. Are you participating for the first time? *
Please answer a few questions:
1. Have there been cases of mental illness in your family? If so, maternal or paternal, and which ones?
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2. Do you have spinal injuries?
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3. Have any surgeries been performed in the last year?
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4. What practices and what masters did you go through?
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5. Do you practice on your own? How regularly and what practices?
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6. Have you ever been seen by a psychiatrist or psychotherapist while undergoing drug therapy? If yes, what is the reason for the referral?
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7. What was your last seminar (retreat) and when?
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8. What interested you in practicing with Maya?
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9. Have you ever had a sleep disorder? (difficulty falling asleep, frequent nocturnal awakenings, early awakenings against the background of unreasonable anxiety)
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10. Have you ever taken any of the following medications:
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Required
11. Do you regularly take any medications? Which?
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12. Approximately how many hours a day do you sleep?
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13. Have you had any experience with teacher plants, hallucinogenic drugs? What?
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14. Do sudden mood swings bother you?
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15. Do you feel that your life has meaning? What are your 3 main passions (hobbies, interests in your life)?
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16. Have you ever thought about ending your life?
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17. Do you ever feel that you are doing something against your will, as if you were pushed from within?
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18. Do you sometimes have bouts of unreasonable fear, bad forebodings?
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19. Have you had cases that you were influenced energetically in order to harm you.
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20. Is there something that you are afraid of? What is the biggest fear?
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21. Have you had any previous experience of learning to dance? What?
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22. What is the concept of «balance»  in your life for you?
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23. Do you often have conflict situations?
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II. Informed voluntary consent to participate in the seminar, host Maya Mandala (Kuritsina Maya Germanovna): 1. Making a decision to participate in the Event: 1.1. I certify that I am at least 18 years of age. 1.2. I confirm that I have no psychiatric and physical limitations: diseases that may create a risk for me and / or other people participating in the Event. In the case of my participation in the Event, I am fully responsible for the consequences of injuries that were in the past. 1.3. I confirm that I have no serious injuries and surgeries over the past 6 months, acute inflammatory diseases, I do not suffer from high arterial, intracranial, ocular pressure, do not suffer from epilepsy, if I am pregnant, I informed the organizers and the host of the seminar about this (for women). In the case of my participation in the Event, I am fully responsible for the consequences associated with my state of health, if I withhold and / or distort this information. 1.4. I confirm that I have received a consultation from the attending physician about the possible risks associated with complications, the occurrence of which is possible in the event of my participation in the Event, diseases, including chronic ones. I confirm that I had the opportunity to discuss with the attending physician all questions of interest and incomprehensibility to me related to the possible risks of complications, the occurrence of which is possible in the event of my participation in the Event, my diseases, including chronic ones. In the case of my participation in the Event, I am fully responsible for the consequences associated with my state of health, if I withhold and / or distort the information received from the attending physician. 1.5. I am aware of the importance of working with psychological states, including those in an altered state of consciousness, I testify about my mental health and, in the case of my participation in the Event, I take responsibility for my condition and behavior.1.6. I confirm that all physical exercises at the Event are performed by me on the basis of voluntary consent. 1.7. I am aware that I perform all the techniques and exercises at the Event voluntarily and consciously with full responsibility for my health and my actions. 1.8 As a participant, I will not demand monetary compensation from the organizers, the host or other participants of the event, as well as prosecute for the deterioration of my physical or psychological condition (of which I was warned about the possibility), as well as the loss or damage to my property. I have provided the truthful information specified in section 1 of the Informed voluntary consent to participate in the Event. 2. I DO: 2.1. Follow the recommendations of the facilitator and her assistants. 2.2. Do not take alcohol, drugs and/or other stimulants the day before, during the Event and within 24 hours after the Event. 2.3. Do not participate in other seminars, trainings and practices during the days of the seminar. 2.4. Maintain a peaceful and friendly environment with all participants and other visitors of the building where the Event is held, in the hall, dressing rooms and other premises. Respectfully treat all participants of the Event. 2.5. Do not use physical actions of a violent nature in relation to all participants of the Event, resolve all conflict situations through negotiations through the organizers and host of the Event. Do not harm the health of others. Take care of the equipment and property in the premises where the event is held and keep it clean. 2.6. Respect confidentiality and not disclose information related to other participants, which was obtained during the Event. This item is permanent. I am informed that for breach of my obligations, I may be suspended from participation in the Event without a refund of the cost of participation in the Event. I am warned that self-audio recording, photo and video shooting, as well as broadcasting during the Event without the permission of the presenter is prohibited! In a form accessible to me, I was given explanations about the goals, methods, nature of the Event, effects, including those associated with the possible experience of negative emotions, the risks of unintentionally causing discomfort, both physical and psycho-emotional, as well as what I have to do during time of the event. It has been explained to me and I accept the condition that the organizer reserves the right to refuse participation in the Event to any participant with a full and / or partial refund of the paid funds without giving reasons at any stage of the Event. I certify that I have read and agree with all the clauses of this Informed voluntary consent to participate in the Event, the content of which was explained to me and satisfies me, it is completely clear to me. I allow my personal data to be transferred to the organizers and processed without a subsequent request for use and notification of the parties. *
I am informed that for breach of my obligations, I may be suspended from participation in the Event without a refund of the cost of participation in the Event. I am warned that self-audio recording, photo and video recording, as well as broadcasting during the Event without the permission of the presenter is prohibited. In a form accessible to me, I was given explanations about the goals, methods, nature of the Event, effects, including those associated with the possible experience of negative emotions, the risks of unintentionally causing discomfort, both physical and psycho-emotional, as well as what I have to do during time of the event. It was explained to me and I accept the condition that the host reserves the right to refuse participation in the Event to any participant with a full and / or partial refund / or no refund of the paid funds (at the discretion of the organizers and the host) without giving reasons at any stage of the Event . I certify that I have read and agree with all the clauses of this Informed voluntary consent to participate in the Event, the content of which was explained to me and satisfies me, it is completely clear to me. I give my consent to the processing of personal data provided by me, including the collection, systematization, accumulation, storage, clarification (updating, changing), use, distribution (including transfer), depersonalization, blocking, destruction of personal data. *
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PHOTO *
Please send your photo to the organizer's email, where the face is clearly visible, without sunglasses, hats and without other people in the frame - vikamira8@mail.ru 
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