ResourceBalance Application Form

This questionnaire is asking information which is personal and private. Your responses will not be used for any purpose beyond the running of this workshop without your consent. Data collected will be deleted after the event is complete.

Please complete all of the fields. Thank you.

ResourceBalance Application Form



First Name


Email Address

Tel / Mobile

Next of kin or contact details of anyone who we might need to contact on your behalf:


1. What is your interest in attending this workshop? What do you hope to achieve from attending?

2. Can we ask what kind of work you do?

3. Can we ask which organisation or company you work for?

4. Are you okay about other people from the same organisation attending this workshop with you?

5. Can we ask how you heard about us?


6. Do you have any experience of Mindfulness / Meditation based practices? If yes, how did you get on?

7. Do you have experience of other practices such as qi gong / yoga / dance / martial movement work? If yes, how did you get on with them?

8. Do you have any experience of giving and/or receiving compassionate / therapeutic touch?


9. Are you open for giving and receiving therapeutic touch with a member of the opposite sex?

10. Are there any sensitivities around touch that it would be helpful for us to know about?


11. What is your level of health and mobility? Are there structural (eg. herniated discs), mobility or sensory (e.g. sound or light sensitivity) issues, that we might need to be aware of?


12. Any other information you would like to share with us.


We understand that participation in a group can sometimes trigger distressing inner material.

1. Can we ask you to stop any activity if you realise it is not helpful in the moment or adjust it to meet your needs. This will be clear in live instruction also.

Is this okay?

2. Can we make an agreement with you, that you'll connect with one of us (however extreme the experience) and not just leave the workshop?

Is this okay?

3. Some of the practices involve physical touch through clothes similar to what might be experienced in a gentle Shiatsu treatment, although we are working within a Mindfulness and Compassionate Connection framework rather than a therapeutic one.

Are you okay about this?

Thank you!
Anthony Fidler & Snezhana Stoeva