Retreat Registration — the embodied healer

A Mindfulness and Yoga Retreat for Health Care Providers

Saturday, April 25, 2020, 10 AM - 4 PM
Sunday, April 26, 2020, 10AM - 4 PM

Little Owl School
3426 Linden Avenue
Long Beach, CA 90807

Name

First Name

Last Name

Pronoun

https://www.mypronouns.org/what-and-why/

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Allergies

Dietary Restrictions

Occupation and Degree

Where do you work?

How long have you been working in health care?

Are you in administration? What is your role? What percentage of your time is devoted to administration?

Do you teach student/residents?

Do you have experience with meditation? If so, where have you practiced and for how long?

Do you have experience with yoga? If so, where have you practiced and for how long?

Is there anything else you would like to share with us to ensure your safety and well being? (i. e. lactation room, sensitive to scents)

How did you hear about this retreat?