Dance As Medicine Facilitator Training Application Form
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Email *
PLEASE TAKE YOUR TIME TO ANSWER THE FOLLOWING QUESTIONS WITH AS MUCH DETAIL AND HONESTY AS YOU CAN, THANK YOU
Full Name *
Phone Number *
Full Mailing Address (including Country and Postal/Zip Code) *
Date of Birth *
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Emergency Contact (Name, Phone, Email, Relationship to you) *
What interests you in taking a Conscious Dance Facilitator Training? *
Tell me about your experience with dance as a healing / spiritual practice? Include any classes, workshops or trainings you have attended and with whom. Mention any books you have read. *
Please provide a description of your current dance practice. *
How long has dance / movement been a practice for you? *
What are your goals and objectives for taking this program? Do you have long-term vision once you have completed the training? *
If you plan to teach others, what does that look like? *
What is the highest vision you would like to create in this training? *
What is a mythical character that represents your inner dancer? (maybe a character from a storybook, movie, play) *
Is dance your spiritual practice or a part of your spirituality?  If yes, tell me more… *
How has dance supported you to overcome challenges or problems in your life? *
What are your greatest strengths and how are you able to use them? *
What motivates you? *
How do you like to be supported and cared for?  What does support look like?  (Think about another training or workshop you’ve attended, what worked or did not work in the way the facilitator supported your process,  your emotions, or any challenges you might have experienced.) *
Do you have any other commitments that could keep you from being 100% present on this journey? (a job, community service, family, etc.) *
How committed are you? (10 being fully committed, 1 being not able to commit at all.) *
If you could change that to any number at all, what would it be?   *
What would have to happen in your life for that to be true? *
What attracted you to this training? How did you find out about it? *
What do you want to get most out of this training? *
Describe your current physical health and indicate any challenges which would inhibit your participation in physical activity at this time? *
This training can bring mental and emotional 'stuff' to the surface. What supports and resources do you have in place to support you when that arises? (ie. counsellor, therapist, bodyworker, etc.) Do you feel well resourced and supported? *
Anything else you want me to know? *
Which payment option do you want? *
Do you have a discount code?
How did you hear about the training? *
Thank you for your time in completing this application form. You will hear back from me soon. ~ Hope Corbin, Ekstasis Dance
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