Full Name

Preferred Name / Nickname:

Age *

Phone Number

Email *

Address

Street Address

City

State

Country

Postal code

Parent/Guardian Information

Parent/Guardian Phone Number *

Parent/Guardian Full Name:

Parent/Guardian Email Address:

Parent/Guardian Phone Number:

Getting to Know You

Why do you want to join The Inner Garden Project?

SWhat are you hoping to learn or experience?

What are your hobbies or creative interests?

Have you participated in any wellness, support, or mentoring programs before? [Yes/No — If yes, please describe briefly]

Medical & Accessibility Information

Do you have any medical conditions or injuries we should be aware of?

If yes, please specify:

Are you currently on any medications or treatments that may affect your wellness plan?

Yes, please specify:

Is there anything else you’d like us to know about you or your wellness journey?

I agree to receive SMS updates from Women to Woman *

Yes

I agree with Mission and Vision of the Organization

Thank you for planting your seed of commitment. We can’t wait to see you bloom! You will receive a confirmation email with program details and next steps.

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