Registration Form
Prior to attending class(es), please print and complete. You may email information to debra@craftingacalmerself.com or mail to Crafting a Calmer Self, LLC, 29 Montvale Avenue, Montvale, NJ 07645. Thank you!
Crafting a Calmer Self, L.L.C.
Everyday Adventures - Registration & Contact Information
Client Information - Please complete form and return to instructor prior to first session.
| Name:
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| Address:
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| Email Address:
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| Telephone (indicate home and mobile):
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| D.O.B.
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| Emergency Contact:
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| Special Needs?
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| Allergies?
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| Sensory needs or preferences?
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| Sensory aversions, including smells or sounds?
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| Favorite interests?
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| Communication challenges we need to be aware of?
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| Physical challenges we need to be aware of?
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| Current Occupation and/or goals?
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| Classes you are interested in taking?
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| What brings you to Crafting a Calmer Self? What are your goals?
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| COVID 19 Protocols - Please indicate if you are able to wear a mask. (Masks are not mandatory for attending at this time. However, masking protocols may be encouraged and/or reinstated as circumstances require such changes.) |
| Please indicate if you require remote virtual instruction. |
Please provide any additional information you feel important on back of form
