Tantric Counselors Course
Enrollment Application

Legal Name

Spiritual Name (if any)

Street Address 

City   State   Zip

Phone   Cell Phone     Fax

Email

Age          Date of Birth             Sex Male Female

Marital Status  Single Married Widowed Separated Divorced Domestic Partnership

Education Experience High School Some College College Degree Graduate Work

Occupation   Job Title

Do you plan to work with Men Women Couples All

Which Class and/or Date are you looking to enroll in?

 Referred By? (if any)   *very important to us

Have you taken Dakini School with Shawn Roop before? No Yes

Do you have any physical or other limitations that might affect your ability to participate in the Tantric Counselors Course?  No Yes (If yes please explain)

Tantra Background (use this space, if necessary, to list previous workshops, events, classes, sessions, teacher trainings, books or experience with Tantra or Sacred Sexuality)

Additional Experience: (list additional transformational, spiritual, healing, psychic experience)

A major part of Tantra is Intention. We would like to hear your Intention for the Class?
(This is very important to us to hear as much as you can share)

Do you have any comments, concerns or hesitations about your enrollment in Tantric Counselors Course?

Please note: Full tuition is due in full before the starting time of the first session.  If you cancel $100 of the tuition/deposit is non-refundable, but may be applied to future Tantric Counselors Course.