Application to Dance with your Higher Self in 2024... a high-vibe fusion of dance and parts work like you've never seen before!
Thanks, from the bottom of my heart, for your interest in this program!  Once you fill out this form, I will be in contact with you about next steps which may include a brief conversation. My goal for the conversation is to ensure that we are a good fit to be co-creating this deeply personal and sacred space together. 
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Full Name *
Email address *
Cell phone number *
Location (Town or City and State) *
How did you hear about this program?  *
Please describe your personal experience with inner work and Internal Family Systems. *
Please describe your relationship to your body and embodiment work.  *
Do you have any history of emotional instability? If so, please describe it.  *
Do you have any physical health conditions that would prevent you from fully participating in this program? If so, please describe them.  *
Describe your closest relationships (for example: spouse, siblings, parents, children, friends).  How do these people support (or not support you) when you need help?  *
Are you currently in psychotherapy? If so, for how long? Is your therapist aware of your potential participation in this program?  *
Disclaimer and Liability Release
It is important to know that this program: 

1) is not intended to diagnose, treat or cure medical and/or mental health conditions. While this group coaching program is an excellent supplement to your overall well being, it is your responsibility to consult or not consult with your health care providers prior to participating. 

2) involves physical exercise, both indoors and outdoors. You are solely responsible for your own safety, as the facilitator and her companies are not liable for any risks you take, including dancing and not dancing. 

3) provides therapeutic benefits, but it is not group therapy. 

4) invites vulnerability around emotional material that could be challenging to deal with. You are responsible for what you share and the impact the material, and the sharing of it, has on you. 

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NEXT STEPS
As mentioned above, after I review your application, I will contact you. If we determine that this program is a good fit, there will be a non-refundable deposit of $200 to hold your space. This deposit is due by February 15, 2024. Once your space is held, we will determine a payment plan that works for you: monthly, quarterly or in full. There are no refunds for any amount paid for this program. 

Finally, I really really really look forward to meeting you! 

With love, 
Leslie ("Les" to my friends and family) 
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