Healing Academy Form - Holistic Healing Institute OU

Name

First Name

Last Name

Date of Birth (exact date, hour and place)

Phone

Adress

Occupation/Profession

Educational Background

Why are you interested in the Healing Academy Program?

What are your personal or professional goals for joining this program?

Do you have any prior experience with healing modalities? (e.g., meditation, energy work, yoga)

Yes

If yes, please describe your experience.

Are you currently practicing or working in a healing-related field?

Yes

If yes, specify your role or area of focus.

Do you have any physical or mental health conditions we should be aware of?

Yes

If yes, please describe.

Are you currently under the care of a healthcare professional?

Yes

Are you able to dedicate the necessary time and energy to the program?

Yes

What do you hope to gain from participating in the Healing Academy Program?

How did you hear about the Healing Academy Program?

Website

Social Media

Friend/Colleague

Other (please specify)

Is there anything else you would like us to know?

Agreement

I have read and agree to the program’s terms and conditions and I understand that this program is not a substitute for professional medical or psychological treatment.

Consent and Acknowledgement

The administrator of your personal data is the Healing Institute Foundation, registered with the District Court for the City of Warsaw in Warsaw, XIV Economic Division of the National Court Register, located at ul. Szamocka 10c/50, Warsaw 01-748, VAT ID: 5253002902, KRS: 0001104388, REGON: 528621437. We will process your personal data solely for the purpose of responding to your inquiry. The legal basis for processing your personal data is the pursuit of our legitimate interests in communicating with users of the website. We will process your personal data for no longer than necessary to provide a response. After this period, we may continue processing your personal data solely for the purpose of defending or pursuing potential claims until they expire. We are entitled to share your personal data only with three groups of entities: Authorized persons – our employees and collaborators who need access to the data in order to perform their job duties. Data processors – external companies to which we outsource activities that require data processing, e.g., IT management of the website server. Other data recipients – as required by law or as necessary to take action in accordance with your wishes. Providing your personal data is voluntary, but it is necessary for us to respond to your inquiry. You have the right to request access to your personal data, their rectification, deletion, or restriction of processing, as well as the right to object to processing, the right to data portability, and the right to lodge a complaint with a supervisory authority.

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Healing Academy Sing Up Form