Request edit access
Poetic Societies | Class Enrollment Form
Commit to your Somatic, Sonic, and Scenic Liberation.
Sign in to Google to save your progress. Learn more
Email *
I take these pills or medical treatments
I eat...
Clear selection
I drink...
Clear selection
I am here to (work on...) *
I have/had injuries in...areas. *
I want you to know that...
I like body-mind practices such as... (yoga, meditation, wellness, exercise) *
My most favorite body postures/positions are...
I practice with my body...time(s) per month
My favorite sceneries are...
My favorite plants are...
My favorite colors are...
I work...hours per week. *
My annual income is
Clear selection
I work...(multiple chooses possible) *
I carry my stress in...areas. *
I feel the mass of being inside me mostly in...areas? *
I feel physical/emotional pain inside me in...areas? *
I love my...(body parts).
I want to love more my...(body parts). *
My high priority areas are *
My legal name is *
I want to be called (if different)
I go by (she/he/they/...)
My mobile number is *
Emergency Contact Name *
Emergency Contact Number *
Address (Apt, St, City, Zip)
I am comfortable with Using LiveLab. *
Date *
Whenever with Poetic Societies, I am the sole entity responsible for my health. I release Poetic Societies from any and all liability as a consequence of my participation in the workshops and yoga classes. *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy