Application for "Embody your Goddess" / Embody Your Goddess Info page / "Embody Your Goddess" Course / Jumpstart! 21 Day Challenge / Fitness

Name *

Email address *

phone number *

What attracted you to this course? *

Which of the following goals for yourself brought you to this course? *

Weight Loss
Reducing Belly size
Getting Back into a Fitness Routine
Improving Mindset, mental balance
Growing Spiritually
Feelin' Sexy
Something Else

If weight loss or belly fat reduction is one of your goals, can you discuss more specific goals *

weight loss (10-20lbs)
weight loss (30 lbs or more)
weight loss (60 lbs or more)
bellyfat reduction (about 1-2 inches or 1 dress size)
bellyfat reduction (about 3 inches or 2 dress sizes)
bellyfat reduction (about 5 inches or 3 dress sizes)

Do you have a more specific goal? *

If your goal is weight loss or fitness related goal. How far along are you on this journey to this goal? *

Just starting
Have tried things in the past
Have seen results but want to continue seeing results
Nearing the end of accomplishing this goal

Do you have a current regular exercise practice? (This is not required) If so, what is it? *

Do you currently have any injuries, chronic illness or are taking any medications that might limit your ability to have a regular workout practice? *

Do you drink, smoke, or take drugs either medically or recreationally? *

Occassional drinker
Heavy Drinker (5 drinks or more at time)
Occasionally smoker
Heavy Smoker
Occasional recreational drug use
Heavy recreational drug use
Occasional medical drug use
Heavy medical drug use
None of the above

Have you ever been to a rehab program for substance abuse? If so, please mention what time periods that was in, and if it was successful. *

What do you think is your biggest obstacle(s) towards reaching your goal(s)? *

What have you tried in the past? And what was the result? *

How much money in your lifetime have you spent trying to reach this goal to date? *

0 - $1,500
$1,500 - $5,000
$5,000- $10,000
$10,000- $20,000
$20,000 +

Do you have access to consistent wifi, email, on your computer, computer camera, and microphone? For the next 12 weeks? Or a mobile user only? *

Yes
No
Mobile User Ony

If you WERE Embodying the Goddess that you wanted to be, how would you speak or act differently from where you are today? (You may have to imagine yourself as that Goddess for this one..." *

Do you believe investing in yourself is one of the most VALUABLE ways to invest in your money? *

Yes
No

On top of the price of 12 week transformation, are you willing to invest additionally to buy yourself fitness gear, apparel, and potentially other materials for the success of this course? (at least $200 additional dollars of personal investment to self) *

Yes
No

Do you believe that it is possible for you to transform your body, mind, and spirit in 12 weeks with through dancing, workouts, meditation, affirmations, and weekly Goddess Circles? *

Yes
No

If you were accepted into the "Embody your Goddess" Course, how would you be willing to commit yourself to it? (Write a statement for yourself) *

Are you open to participating in a weekly or monthly Zoom call individually or with a group? *

Yes
No

What is your favorite mythological creature (griffins, unicorns, mermaids, etc)?

Is there any additional information you would like to provide?