Healing Circle Registration Question Title * 1. Name: (Required.) Question Title * 2. Email: Question Title * 3. Phone: Question Title * 4. If we need to contact you with a group update, how should we do this? Phone - safe to leave a message Phone - please do not leave a message Email Question Title * 5. Please indicate which days you would like to attend group: (Required.) September 14 from 5:00pm-6:00pm October 9 from 5:00pm-6:00pm November 16 from 6:00pm-7:00pm December 8 from 7:00pm-8:00pm Question Title * 6. Do you require childcare during the selected group dates above? (Required.) Yes No Question Title * 7. If yes to childcare, what age(s)? Question Title * 8. Do you have any dietary restrictions or allergies? Done