Registration Form

First Name*
Last Name*
Email*
Date of Birth*
Phone*
Class Start Date*
Address*
Emergency Contact Person*
Emergency Contact Phone*
What is your current practice
What is your experience/education background as it relates to practicing and/or receiving Bodywork?
What do you hope to get from this workshop?
Have you experienced a CranioSacral Therapy session before?
- Yes
- No
Have you had any somatic emotional release work before?
- Yes
- No