Questionnaire and agreement prior to your participation

To complete your registration, please fill out the questionnaire and agreement form below.

This questionnaire is confidential and is reserved for the exclusive use of the facilitators of this training. Its sole purpose is to give teachers as many elements as possible in order to accompany you in the best possible way.

First name *

Last name *

Email *

Please upload a small picture of you.
These photos will be used by the team during the workshop to help us remember names and faces. They will only be used for the purpose of this workshop and will not be distributed without your permission.
(Accepted formats : jpg, png, pdf. Maximum size : 2Mb.)

Your picture

Why have you chosen to participate in this workshop? (on the personal, sexual, relational and/or professional levels) *

Do you practice or teach any personal development or therapeutic techniques? If yes, what? *

Have you ever done any therapy work? If yes, what kind of therapy: analytical, energetic, or other? Individual, couple or in a group? *

How do you feel about your body and your sexuality? Is there anything about your sexuality that you feel we need to know in order to better accompany you? (e.g., your sexual orientation, whether or not you are in a relationship, etc.) *

Is there anything about your health that you feel we need to know in order to better accompany you? (e.g., recent major illness or operation) *

Are you currently seeing a doctor? Do you follow any medical treatment or take any medications (including anxiolytics or antidepressants)? If yes, for what reason? *

Do you feel you have experienced traumatic situations that would be important for us to know about? Do you feel you need any particular support regarding these issues or do you feel you have worked through them ? *

Is there anything else that you would like us to know, considering that we are going to work together on the physical, emotional and energetic levels? *

Participant’s agreement

I take full responsibility for my experience and choices during this workshop.
In all activities proposed, I agree to: monitor my participation, be mindful and responsible for my state of being, take care of my nutrition, get enough rest, and not exceed my own physical and emotional limits.
I assume all risk from any consequences due to any pre-existing physical or psychological conditions that I may have.
I agree to refrain from consuming any form of recreational drugs 24 hours prior to the starting time of and while attending the training.
I assume all risk that could be linked to the medications that I usually take.
I agree to release and discharge the teachers, assistants and organizers from any and all liability arising out of my participation in the training.

Do you accept these commitments? *I have read these commitments and accept them fully.

Person to contact in case of emergency *

Phone number of this person *

Use and storage of personal data *I accept that in the process of registration, this information will be recorded and used by the ShivaShakti association and the SkyDancing Tantra Francophone Institute within the framework of their confidentiality policy.