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Registration for SHIBUI Workshops (2024)
*
1.
Who is filling this form out?
(Required.)
Support worker with/on behalf of an individual
Individual interested
Family member on behalf of an individual
Other
Company/Business
Coordinator of Supports on behalf of an individual (name and contact details)
*
2.
What workshop would you like to register for?
(Required.)
Healthy Relationships Workshop
Wellbeing Workshop
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3.
Name of individual interested
(Required.)
4.
What are your pronouns?
She/Her
He/Him
They/Them
Other (please specify your pronouns)
5.
Date of Birth
Must be 18 or older
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
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1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
6.
Any dietary requirements?
No
Yes
7.
Do you require any supports to access this workshop?
No
Yes (please specify what type of supports)
8.
Is there any other information you wish to tell us or think that we should know? This may include past trauma or topics that may trigger some negative emotions. This will help our support persons support you best.
9.
Can you please specify what your disability is.
*
10.
Contact details
(Required.)
Address
*
Address 2
City/Town
*
State/Province
*
ZIP/Postal Code
*
Country
*
Email Address
*
Phone Number
*
Thank you for registering for our Shibui Workshops. Following the completion of this registration, our team will get in touch with you. - Shibui Team
