This questionnaire is an excellent exercise for you to do in preparation for your experience, as it will make you think more deeply about why you want to do it and what you are hoping to achieve. This is not an exam and you can’t pass or fail. Your answers will be kept confidential. Please, take this exercise honestly and gently.

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Name

First Name

Last Name

Email

Phone

(###)

###

####

What is your intention for this experience?

What are you hoping to gain from it?

What are your biggest challenges around saying YES in your life ?

What are your biggest challenges around saying NO in your life ?

Have you been or, are you currently under psychologic or psychiatrist treatment?

What's one barrier to participation that you can identify?

What are one way, or some ways you can resource yourself during this experience? (Ex: have a friend to debrief after each session, journaling, exercising, dancing, etc.)

This questionnaire is an excellent exercise for you to do in preparation for the workshop, as it will make you think more deeply about why you want to do it and what you are hoping to achieve. This is not an exam and you can’t pass or fail. Your answers will be kept confidential. Please, take this exercise honestly and gently. .

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