Registration form for human guests

This form should be completed for all human guests to be included in an upcoming event. It's best if they fill in their own details, but if that's not possible, please complete the form on their behalf. All info that is shared is is treated with complete confidentiality.

Q1 - Q4 require an answer, but if you do not have the info, please write "unknown". Q5 - Q9 are optional - feel free to include as much or as little info as you like.

Send the form by clicking the 'Done' button at the bottom of the page when you have finished, or if you prefer to send it via e-mail, just copy and paste the completed form (without clicking the "Done" button) into the body of an e-mail and send it to Edna's personal mail or to earthhealadmin[at]gmail[dot]com

We will be in touch with you via e-mail as soon as possible.

* 1. Your name - Earth Heal member

* 2. In which event will your guest be participating?

* 3. Guest participant's personal details:

* 4. Guest's location during the event (nearest town/city, state, country):

* 5. Please list any health issues your guest needs help with, surgeries they have had and medications being taken:

* 6. Important periods and dates in your guest's life - include traumatic or stressful times and events, accidents, injuries, deaths, births, miscarriages or abortions, divorces, marriages, loss of job, moving home etc.:

* 7. Please list any specific problems/challenges your guest would like the treatment to focus on:

* 8. Your guest's personal focuses for this event:

* 9. If there is any other relevant info you would like to share with us, please do so in the box below:

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