Registration – Holistic Rewiring

A Project by Holistic Rewiring of Your Physical and Mental Health by Nature’s Plate) Welcome to Harmony Academy, Miles 🌿 Please take a few minutes to answer these questions — they help us understand where you are on your journey and how to best support your healing and learning path.

Registration
Personal Connections
Lifestyle & Health Awareness
Learning Intentions
Emotional & Soul Awareness
Program & Logistics
Final Reflection

1. What helps you feel most centered or peaceful? *

Music
Meditation
Writing
Art
Nature walks
Ocean Healing
Conversations with trusted people
Quiet solitude

2. How do you usually express emotions? *

Talking / sharing
Writing / journaling
Creative arts or music
Silence or movement

3. Are you currently going through a major life transition? *

Yes (Please share briefly if you wish)
No

Please share briefly if you wish *

4. What does “healing” mean to you? *

Reconnecting with my true self
Releasing old patterns or pain
Building physical and mental strength
Living with awareness and compassion

5. What kind of support do you value most in a learning space? *

Gentle guidance and understanding
Structured discipline and accountability
Space for creativity and self-expression
Community connection and belonging

1. Preferred timing for sessions: *

Morning (9 AM – 12 PM)
Afternoon (1 PM – 4 PM)
Evening Workshop (6 PM – 7 PM)

2. Mode of participation: *

In-person at the Academy
Online (Zoom / virtual)
Hybrid (mix of both)

3. Dietary preference: *

Vegetarian

Note:- At present, all our meal plans are vegetarian.

4. Do you need any assistance with stay, transport, or accessibility? *

Detail *

5. How did you hear about Holistic Academy? *

Instagram / Social Media
Website
Word of mouth
Workshop or event
Other

Please Share *

1. How is your daily energy level? *

Steady and calm
High but scattered
Low and fatigued
Depends on the day

2. Do you have any health conditions or injuries we should be aware of? *

Yes (please specify)
No

Please specify *

3. Are you currently under medical or therapeutic care? *

4. How would you describe your self-care habits (sleep, food, rest)? *

Excellent — I maintain a balanced routine
Moderate — I try but need more consistency
Poor — I neglect my own needs often

5. How often do you spend time in nature or movement? *

Daily
A few times a week
Occasionally
Rarely

1. Which areas of learning interest you most? *

Meditation & Mindfulness
Yoga & Breathwork
Art & Expression Therapy
Nutrition & Conscious Cooking
Event Planning / Leadership
Sound Healing / Nature Therapy
Business Skills (Bookkeeping, Café Management)

2. What kind of learning rhythm feels right for you? *

Short, 4–6 week focused sessions
Extended, 8–10 week programs
Full membership plan (ongoing learning and healing)

3. How much time can you dedicate per week? *

3–4 hours
6–8 hours
10+ hours

4. What kind of setting do you prefer? *

Group learning with others
One-on-one personalized sessions
Mix of both

5. Which membership plan are you most drawn to? *

Monthly — sample two programs
6-Month — steady growth with retreat
12-Month — full immersive experience

1. What inspired you to join Holistic Academy at this time? *

I want to focus on my healing journey
I’m going through life changes and need grounding
I want to learn new skills / self-growth tools
I was recommended by someone
Other

Other *

2. How would you describe your current emotional space? *

Calm and balanced
Seeking clarity
Emotionally heavy or tired
Overwhelmed but hopeful
Open and curious

3. What are you hoping to experience through this program? *

Inner peace and mental clarity
Physical health and strength
Emotional release and healing
New creative or professional skills
Connection with like-minded people

4. Have you attended holistic or healing programs before? *

Yes, regularly
Once or twice
Never

1. What is one word that describes how you want to feel after this program? *

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2. Is there anything else you’d like to share or we should know before we begin your journey? *

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Captcha * =

With gratitude, Holistic Academy Team — Maryceline Rani Holistic Rewiring by Nature’s Plate

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