$1,600.00 AUD

First Name

Lastname

Address

Phone Number

Date of Birth

What previous training do you have in Rites of Passage / Somatics / Embodiment / Womens Work?

Have you done any dance before?I have completed LEVEL 1 with EclecticaI have completed one of Eclectica TrainingsI have done some dance beforeI have a background in choreography

Nickname

Pronouns

Please note that the following responses are strictly confidential, however will be privately shared with your facilitators so they best know how to support you during your time with us. Any mental health diagnosis?

Are you Neurodivergent?

If YES, please specify, and we invite you to share how we can best support you, or facilitate in a way that accomodates your unique learning style or retainment of information

Are you on any medication?

If YES, please specify Emotional Support Requirements (if Any) *

Requirements for those with complex unresolved trauma * If you do have complex, unresolved trauma or PTSD, we recommend working with a trauma-trained specialist for the duration of your participation in the Eclectica Container so they can support you to fully integrate the content we move through in class. If this applies to you, is this something you are willing to do?

Do you have any sensitivities around sound? Eclectica Hub work a lot with sound and we also encourage the release of emotions via sound. Do you have any sensitivities or trauma surrounding sound?

Payment Plan Agreement Please note that all payment plans must be completed befor. I agree to pay off all all instalments of my payment plan after the completion of my training with Eclectica Hub the commencement of the semester. If you are on an extended payment plan and your payment. plan is scheduled to finish after the completion of the semester, you must sign the financial contract below stating that you agree to continue payments until financial agreement / payment plan is completed.

REFUND POLICY * This course is strictly non refundable. In the event of extreme crisis of illness participants may apply to transfer their course fees to a future course or training with Eclectica OR privately sell their space to a friend. Please note that it is YOUR responsibility to find this friend - not Eclectica. When securing your space you must agree to these terms and conditions and understand the following: - The course is strictly non-refundable. - Transfered fees must be used within an 18month period. - Students that wish to transfer their fees due to extreme crisis or illness will need to apply through Eclectica Hub - and will require to send a Doctor's Certificate or adequate evidence. - Students that privately sell their space to a friend, MUST notify Eclectica of the name change at least 14 days before the commencement of the semester.

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New Zealand 2025 - Pay In Full

REFUND POLICY:

This course is strictly non-refundable.

In the event of extreme crisis of illness participants may apply to transfer their course fees to a future course or training with Eclectica (either online or in person) OR privately sell their space to a friend. Note that is is your responsibility to find this friend, not Eclectica’s.

When securing your space, you agree to these terms and conditions and understand the following:

In the event of extreme crisis of illness participants MUST prove this by showing a Doctor’s Certificate or something of similar validity.
Transfered fees must be used within an 18month period.
Eclectica must be notified of any name changes at least 48 hours before intensive commencement.
Application to transfer fees due to crisis or extreme illness but be requested a minimum of two weeks before course commencement.