Name:

Address:

E-mail:

Phone/Cell phone:

Person to contact in case of an emergency (name and number):
 

I want:

vegan food gluten-free food

I'm allergic to:

I understand that I am participating in a workshop which is not a substitute for therapy and I am responsible for participating in a way that I can manage (psychologically. physically and emotionally).
I understand everything that happens in the workshop is voluntary and that I am not compelled to do anything I feel uncomfortable with. I take full responsibility for my own boundaries and for not doing anything I don't like to do.
I will respect the boundaries of the other participants. I understand that "no" means "no".
I will not use violence or force against myself or anyone else during the workshop.
I will not use any alcohol or drugs during the workshop.
I will not leave in the middle of the workshop without notifying the hosts and I will not invite outsiders to the workshop.
I understand and agree that everything said or done during the workshop is confidential. I agree not to use real names or reveal explicit details of anything that happens inside the workshop with anyone outside the workshop.
I agree not to take photos or make audio or video recordings while in class.
I will inform the hosts about any diseases, stds, allergies, psychiatric treatments, physical dysfunctions, pregnancy, recent surgeries, or medications that might have an impact on my participation or other people's safety.

Important information about me:
  

I have read and understood the above agreements and I understand that breaking any of these agreements will lead to my dismissal from the workshop without refund.

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How did you hear about the workshop?
  

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