Request edit access
Student Information Form
Please fill this out so I have an official record of my students for class, thanks!
Sign in to Google to save your progress. Learn more
1. First Name *
2. Last Name *
3. Preferred Name / Nickname *
4. HOW DO YOU WANT YOUR NAME on the certificate? *
5. Mobile Phone *
6. Email Address *
7. Street Address where you live *
8. CITY where you live *
9. ZIP Code *
10. What city will you be coming from when you head to class? (Often people work in a different city from where they live.) *
11. How did you hear about this class? *
12. Are you on FACEBOOK? If so, what is your Facebook name, if it's OK to friend you: *
13. Is it OK to share your contact info with classmates? Later in the semester, there may be some homework that will invite you to contact each other during the week. *
14. BEST METHOD OF CONTACT that you consult EACH day, in case of urgent communications: *
15. Please note any contact methods you DON’T want me to use (if any): *
Required
16. Are you able to meditate? *
17. Do you already know any of your Spirit Guides? *
18. YOUR EXPECTATIONS for class/What you want to achieve or improve/Why you’re taking class: *
19. NOTE: Refunds are allowed only if the class series is cancelled or the start date is changed, and full payment is expected whether you attend all classes or not. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms