Wild Medicine Dance Training  2021 Application Form

    If you have difficulty with the form, don't hesitate to ask us for help.

    A * means that the question is compulsory, you won't be able to send the form without it.

    *Please tell us below which week(s) you're applying for:

    *Your Full Name

    *Your Address (please include your country)

    *Date of Birth (dd/mm/yyyy)

    Please upload a photo of yourself so your tutor will recognise you. Click the browse button to find your photo on your own computer, then simply select the file. It will be uploaded automatically when you send the form. Maximum file size is 1MB and acceptable file types are *.gif, *.png, *,jpg, *.jpeg. Contact us if you have difficulties!

    *Your email address

    Home Telephone (include country code if applicable)

    Mobile Phone (include country code if applicable)

    Course updates

    How and where did you hear about the course? You don't need to complete below unless this is where you heard about the course, and brief details are fine.

    Leaflets (where?)

    Magazine or newspaper ad (details?)

    Website (which one?)

    Other (please specify)

    *Would you like to join our Goddess Temple Mailing List? You will receive updates and information about courses and occasional Goddess Temple and Goddess House news. You can, of course, choose to unsubscribe at any time. By ticking the "yes" box below you acknowledge that you have read our Privacy Policy.

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    Information about Fees

    This section is for information only - you can pay your fees from the individual course application page
    Week One Fees

    Earlybird fee (paid in full on or before 20th April 2021): £395.

    Full fee (paid between 21st April and 21st June 2021): £425

    For the full fee there is a deposit of £100 to be paid by 1st June 2021 at the latest with the balance paid by 21st June 2021.

    Week Two Fees

    Earlybird fee (paid in full on or before 20th June 2021): £395.

    Full fee (paid between 21st June and 11th August 2021): £425

    For the full fee there is a deposit of £100 to be paid by 24th July 2021 at the latest with the balance paid by 11th August 2021.

    More about you: your experience and expectations

    Please fill out the following questions as fully as possible so that your tutor can get a sense of who you are. The Glastonbury Goddess Temple will hold all information given in total confidence. Each of the text areas below will expand to allow 512 characters (with a counter below to let you know where you're up to). If you need more room, please send us a separate email with further details. It will help if we can easily cross-reference an email with your form, so please include in the email your full name, address and the course you're applying for.

    Current occupation/vocation


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    Why do you wish to participate in this training?


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    What previous experience, if any, have you had in this area?


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    What are your expectations from this training?


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    Is there any other relevant experience or training you would like to tell us about?


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    About your health

    Because the nature of these trainings is transformative and energetic it is important for the teacher to know of certain mental & physical conditions. Answering these questions enables us to ensure your safe participation within the group and to recognise those times when it may be wiser to observe rather than to participate. It is a requirement for you to answer the following questions. All information is held in total confidence.

    Do you suffer from any of the following conditions? (If necessary you can select multiple conditions by holding down the "Control" key and selecting as required).

    *Do you have, or have you had, any medical problems of an acute or chronic nature?

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    *Have you ever had any mental health problems diagnosed or treated?

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    *Do you have any physical needs that it would be useful for your tutor to know about?

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    *Are you taking any drugs, prescribed or otherwise?

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    If you have included any of the conditions above, please give details. The text area below will expand to allow 512 characters (with a counter below to let you know where you're up to):


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    Terms & Conditions

    We do need you to sign a paper copy of the Terms and Conditions before you can be accepted on any course. Please download and print the Terms and Conditions now, then sign both copies and return one to us, with a note of your name and address.

    If you don't have access to a printer, click here to request us to send you a paper copy of the Terms and Conditions.

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    Acceptance of Terms & Conditions

    The form won't send without your acceptance

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