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Coolbinia, Western Australia 6050
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Home
Work with Me
Returning Home Programme
Returning Home Session
Events
Radical Rest & Restore
Action Centre
Blog
Contact
Contact
Registration Form
Feedback Form (Events)
Registration Form (1:1)
Registration Form
Name
*
First Name
Last Name
Pronouns
Email
*
Phone Number
*
Date of Birth
*
How did you hear about the event?
Karen's newsletter
Attended a previous event
Google
Word of mouth
Other
Have you done an Embodiment Practice before? If yes, please share a little about it..
What do you hope to take away from the event/1 on 1 session?
Emergency Contact Name and number
Please provide details below of any injuries or issues that may impact your embodiment practice e.g. pregnancy, old injuries, blood pressure issues, heart problems, mental health, on-going illness etc
*
By checking the box below and submitting this form I agree to being subscribed to the mailing list of Karen Grant and that I have read and answered the above questions to the best of my knowledge. Where I answered Yes to any question I agree that I have discussed the issue with my Doctor to ensure that it is safe for me to begin. I undertake all movment practices and events, workshops, classes freely and voluntarily and understand that Management, staff and instructors will not be liable for any personal injury arising through participation. I further undertake to advise the teacher before the commencement of any class if for any reason my ability to move has changed.
*
I have read and agree with the above statement
Thank you!