Guardian Intake Request

Your Name (required)

Your Email (required)

Cell Phone

Address
Street

Apartment

City

State

Postal Code

Date of Birth (mm dd yyyy)

On a scale from 1-10 (1 = not at all, 10 = Very, 100%)

Experienced in healing?
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Do you have the flexibility to travel?
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Are you financially stable?
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Do you have experience in selfless service?
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Are you interested in continuing an education on services that help humanity?
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How active are you on social media?

Comfort working in large of groups?
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Refined people skills?
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Flexible?
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Non Violent Communication?
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Interested in the true origin of humanity?
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Religious?
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Spiritual?
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Sober?
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Awake?
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Conscious around nutrition?
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Name 3 of your favorite teachers
Teacher #1
Teacher #2
Teacher#3
Name 3 of your favorite books
Book 1
Book 2
Book 3
Why are you interested in becoming a Guardian for The Breath Center?