Registration Now - Dance Hammers

Full Name

Email Address

Mobile Phone Number

Emergency Contact Name

Emergency Contact Phone

please Non to

Ceremony Name

Allergies or Dietary Restrictions

Accessibility or Mobility Needs

Are you currently taking any medications that may affect your mood, energy, or emotional state?

Yes
No
I prefer to discuss this privately

Examples include antidepressants, anti-anxiety medications, ADHD medications, sleep aids, or prescription pain medications. This helps us create a safe and supportive experience.

If yes, please list the medication(s) or share anything else you'd like us to know:

This information will be kept confidential and used only to support your wellbeing during the program.

Preferred Payment Method

Alcohol and Drug Policy

I agree not to consume alcohol or other mood altering drugs during ceremonies

Total

$0.00

Address

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