Registration Name * First Name Last Name I am registering for: * Scarlet Codes Immersion Email * Phone * (###) ### #### Instagram Handle (to contact you if we need) Date of Birth MM DD YYYY Have you attended an offering with us before? Yes No Please tell us about your previous movement experience What brought you to this particular expereince and what are you hoping to gain? How many years have you had a movement practice? Are you taking any medications? Do you have any current or recent injuries? Yes No If yes, please tell us more Do you suffer from mental health, anxiety, depression or trauma? ( It is important that we are fully informed of such challenges prior to the training.) Yes No If yes, please be thorough and list in detail Is there anything else we should know? How did you hear about this immersion? Thank you we will be in touch shorty with our response!
