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Self-Care Challenge Registration Form
August 2024
First name
*
Last name
*
Email
*
Phone
Occupation
*
What are your main goals for joining the Self-Care Challenge? (Please select all that apply)
*
Reduce stress and burnout
Improve physical wellness
Enhance emotional well-being
Foster mental clarity and focus
Build a supportive community
On a scale of 1-10, how would you rate your current level of stress? (1 being the lowest, 10 being the highest)
*
1-2
3-4
5-6
7-8
9-10
What specific areas of self-care are you most interested in exploring during this challenge?
*
Physical activities (e.g., yoga, walking)
Mindfulness and meditation
Nutrition and healthy eating
Emotional resilience techniques
Time management and productivity
Other
Consent to Follow-Up
*
Yes, I agree to be contacted after the challenge for feedback on my progress towards my goals.
Please share any additional comments or expectations you have for this challenge:
Submit
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