Awakening Through Radical Self-Love Application Form
Thank you for your interest in the 8 week Sacred Healing Journey of Awakening Through Radical Self-Love. Filling out this application form will help both of us to determine whether taking this program is the right step for you at this time.
Full Name *
Email *
Telephone Number (cell preferred) *
Where do you live? (city, country) *
How did you hear about this program and/or Shaeah? *
Which class are you interested in attending? *
How ready are you to take full responsibility for yourself and your life? *
not at all
completely
What are your top 3 greatest struggles right now? *
What other personal and/or spiritual growth work have you done? *
If you were to have a breakthrough or healing in any area of your life what would you like it to be? Describe your deepest heart's desire in as much detail as possible. *
What kind of support has helped in the past? *
What kind of support hasn't work for you in the past? *
Are you willing to commit to the full program (attend all classes unless there is an emergency) and participate as fully as you can? *
Are you willing to have a beginner's mind, try new things and be open to new ways of experiencing yourself, life and others? *
What's your level of over all Self-Love right now? *
not at all
radically amazing
Love for and connection to your body? *
Relationship with and connection to your heart? *
totally disconnected
amazing
Relationship with and connection to your mind? *
like enemies
total allies
Relationship with and connection to your spirit? *
not at all
solid & profound
Do you agree to the following agreements? 1) To hold in confidence whatever anyone shares in the group. 2) To be on time for each session unless unavoidable and will communicate so, as soon as possible. 3) To take responsibility for your own needs and make requests when needed. 4) To hold a compassionate non judgemental space for others in the group. 5) To trust and honour your own pace, process and needs. 6) To not give advice (to trust and honour others' process). *
Required
How much would you like to pay? *
What method of payment would you like to use? *
Clear selection
Anything else you would like Shaeah to know?
If you would like to apply for a scholarship please state the reason why and for how much? $100 or $200?
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