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Poetic Societies | Class Enrollment Form
Commit to your Somatic, Sonic, and Scenic Liberation.
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I take these pills or medical treatments
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I eat...
Veggies
Seefood
Meat
Vitamins
Minerals
Other:
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I drink...
Sugar
Salt
Flat
Sparkling
Alcohol
Coffee
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I am here to (work on...)
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I have/had injuries in...areas.
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I want you to know that...
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I like body-mind practices such as... (yoga, meditation, wellness, exercise)
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My most favorite body postures/positions are...
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I practice with my body...time(s) per month
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My favorite sceneries are...
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My favorite plants are...
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My favorite colors are...
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I work...hours per week.
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My annual income is
Below 20,000
Below 40,000
Below 60,000
Below 80,000
Over 80,000
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I work...(multiple chooses possible)
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I carry my stress in...areas.
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I feel the mass of being inside me mostly in...areas?
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I feel physical/emotional pain inside me in...areas?
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I love my...(body parts).
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I want to love more my...(body parts).
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My high priority areas are
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feet/ankles
knees
hips/groins
abdominals
middle or lower back
upper back/shoulders
neck
emotional stability
mental/intellectual clarity
trauma
injury
illness
Other:
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I want to be called (if different)
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I go by (she/he/they/...)
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My mobile number is
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Emergency Contact Name
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Emergency Contact Number
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Address (Apt, St, City, Zip)
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I am comfortable with Using LiveLab.
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Date
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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.
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