Name
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First Name
Last Name
Email
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Phone
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Country
(###)
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Address
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This address will be used to send you sacred medicines for our container. :)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
INTENTIONS + EXPECTATIONS
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What called you to this Sacred Womb Path at this time?
> Do you have any intentions, desires or expectations you are bringing into this journey?
> Have you done any womb healing work before? If yes, what kind? (e.g. yoni steams, breathwork, ancestral work, grief work, somatic practices, etc.)
ACCESSIBILITY + NEEDS
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Do you have any accessibility needs or requests you'd like us to know about?
Do you have caregiving duties that may also impact your participation + presence to take time to nurture yourself - what will you need to support you?
WHOLE BEING WELLNESS
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*you are welcome to share as little or as much as you wish.
> Are you currently under the care of a doctor, midwife, or healer for any womb-related health issues?
> Are you taking any medications, herbs, or hormone therapies?
> Are you open to receiving support during ceremony if strong emotions or memories arise?
CREATIVE PRACTICES + RITUALS
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The womb space is a sacred centre for all creation.
Do you engage in any creative practices and rituals? Please share about what you enjoy creating.
What is your experience with 'creating' and expressing yourself through the arts, your body, rituals, and your spirit? Do you experience any challenges when it comes to the idea and embodiment of creating and expressing yourself creatively?
LIVED EXPERIENCE + SAFETY
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Do you currently experience or have you experienced any of the following?
(optional checkboxes or written response)
***This is a sacred and confidential space. You are not required to share anything you don’t feel ready to. This is to hold your story with tenderness and support your experience in this circle
is there anything you wish to share or elaborate on?
EXCHANGE / PAYMENT
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Which payment exchange are you offering?
**Please self-assess honestly. This is a sacred container of mutual trust, reciprocity, and community care.
$2,222 – Abundant Supporter
> For those with financial stability, access to disposable income, or the ability to support others in accessing this program. Choosing this rate helps fund scholarship spots and support our guest healers and facilitators equitably.
$2,000 – Sustainer Rate
> This is the actual cost of the program. Choose this if you can meet your basic needs and have some expendable income. This rate supports a sustainable energy exchange.
$1,888 – Community Rate
> For those who are low-income, caregivers, students, or in a place of transition. Choosing this rate offers access while still investing in your healing journey.
**There is a $150 CAD non-refundable fee for completing registration for Sacred Womb Path which will be deducted from your total fee. An email will be sent to you to complete this fee to hold your spot.
Please select one:
How do you wish to make payments?
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Please share details of your payment plan.
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If you require support with this, please let us know here.
Message
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please feel free to share anything else you wish, including questions or comments.
> What are you most excited about in joining this sacred container?
Thank you for Registering!
We are so excited you are committing to your womb healing alongside community! THANK YOU for choosing to do this sacred care work and re-membering!
Jen will be in touch with you soon regarding the completion of your registration! :)
