Bodies of Culture Healing Circle
This event is open to Black, Indigenous, and other People of Color. To ensure a safe and healing environment, this is a closed space with limited capacity open to those that will benefit the most. The event will take place on Saturday, July 29, 2023 from 12:00pm to 1:00pm PDT. Your completed form will be reviewed and you will receive a registration link if approved. If you have any questions, please email disruptotsummit@gmail.com
Sign in to Google to save your progress. Learn more
Are you Black, Indigenous, or another Person of Color? If no, please do not submit form. *
What is your racial and/or ethnic identity? *
Name *
Email address (if approved, registration link will be sent here) *
Pronouns
Country
Have you experienced racism directed towards you? *
How do you currently cope/heal from racial trauma? *
Are you willing to talk about and possibly guide the group through a short (~5 minutes) healing activity that you find beneficial? e.g. deep breathing, movement, mantra, etc. *
Are you comfortable talking in small groups about how to build a support system? *
Are you willing to make space to allow all participants equal speaking time? *
Are you available and do you intend to participate in the full 60 minute session on Saturday, July 29, 2023 from 12:00pm to 1:00pm PDT? Space will be limited and active engagement is expected, so we ask that you answer honestly and with consideration of others in the group. *
What do you hope to receive from this group? *
What do you hope to offer this group/members of the group? *
Do you have any accessibility needs or concerns? The event will take place over Zoom and captions will be available. You will be invited to speak and participate in various healing modalities that may require physical movement.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Sheela Ivlev, MS, OTR/L. Report Abuse
Google Forms