Name of Workshop / Course
Date of Workshop
Full Name
Your Email
Date of Birth Please enter DD/MM/YYYY (e.g. 23/12/1980)
Your Address
Mobile Number
Phone Number
Do you have any special needs e.g. mobility issues etc.?
Are you a smoker? YesNo
If a certificate is to be issued on completion please confirm how you would like your name to be shown
Please Note
The energies in this workshop are very powerful & can affect people in different ways. It is a condition of booking that students attending this workshop inform the facilitator if they have any past or current history of the following: problems with alcohol and/or drug abuse, problems in the past, or currently experiencing problems, with mental issues where those issues are being treated with medication; if you have any other medical condition or disability which may require special arrangements, or that you feel I should be made aware of, for example, but not exclusively, diabetes, angina, epilepsy; if you are currently taking or will be taking any medication during the workshop; if you have previously been affected in any adverse way during any energy work. It is your responsibility, for your own well being, to inform and discuss with the facilitator any of the above before booking this workshop.
I have nothing to advise the facilitator ofI have advised & discussed with the facilitator my condition/ medication/ situation & accept responsibility for my own well being.
Any other information that you wish us to be aware of?
How did you hear about this Crystal Heaven event?
Please view and read our Ts&Cs. I agree to the Ts & Cs
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