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healing art circle by jabeen at pitstop / intake form
Please fill this form out. You will receive a Whatsapp message for payment details. All other information will be confidential and only used to create a great experience for you.
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What is your name?
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Your answer
What is your occupation?
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Your answer
How did you find out about this circle?
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From Pitstop's social media
From Jabeen's social media
A friend shared with me
Other:
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Why did you decide to sign up for this circle?
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Your answer
Have you ever attended a similar event or session before? What was your experience like? (Write null if you haven't)
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Your answer
What is your #1 struggle right now?
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Your answer
What is your #1 desire?
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Your answer
If you have any mental or physical illness or disability please let us know. This is a chronic illness inclusive space, however, it's not a replacement for medical help.
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Your answer
This circle is meant to be a safe space for all genders, religions & races. There will be no judgements, sexism or religious extremism . Do you agree to try your best to maintain these rules?
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Yes
No
Other:
Please leave your WhatsApp number so we can send you payment details & your spot can be confirmed
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Would you like to receive Whatsapp reminders for similar events so you don't miss out? {no spamming or groups}
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No
Anything else you'd like to mention or ask. e.g you're getting spots for friends, etc.
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Your answer
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