Teacher Training Intake — First Responder Sleep Recovery

Welcome, we are thrilled you will be joining us!

If you are seeking to learn about the healing of trauma, stress, and sleep, you’re exactly in the right place. Whether it is for professional or personal reasons, we look forward to your presence in this educational and experiential immersion and certification training.

Registration has ended, the event is sold out.

If you are enrolled, please complete the IMMERSION & Teacher training REGISTRATION form & waiver below by April 1st, thank you!

Name

Please type your legal name (and how you'd like it presented on your printed certification)

First Name

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Please note if there is a nickname you prefer to be called by share it here, otherwise type "N/A"

First Name

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Emergency Contact

Name, Email, Phone & Relationship

What is your primary interest in attending this training?

For example: personal self care, or I'd like to bring the 8 week program back to my organization & facilitate the classes

Who referred you to this Teacher Training?

What do you hope to gain from this training?

You will receive education from the founders of the First Responder Sleep Recovery Program, Jacqueline & Sean Toomey and other practitioners in the field of health and wellness and their specialties include: Somatic Experiencing Practitioner, trauma informed breath work, sleep science (on shift work impact / health consequences), Ayurveda, trauma informed Yoga and Trauma Informed Yoga Nidra. What questions do you have about any of these modalities that you are curious about?

Please be ask specific and detailed as possible. We will pass your questions along to the instructors so the program is tailored with you in mind!

Please describe what you know about sleep science.

Please describe what you'd like to learn about sleep science.

Examples: Shift work, diet, long term health, sleep hacks etc.

Please describe your experience with Somatic Practices for Self Awareness and Healing (If you're brand new, welcome!)

Please describe what you currently practice for your wellness (if there isn't anything that comes to mind, that's okay!)

What areas of your mind / body health would you like to improve?

Rate your Sleep

On a scale of 1-10, 10 being phenomenal fabulous sleep & 0 representing poor sleep, how would you generally rate your sleep? (Get real with us, there is no judgement here and our purpose is that we are here to support you!)

How would you describe your sleep?

How many hours do you typically sleep?

What sleep strategies do you currently have that are working for you?

What sleep strategies do you have that are currently not working for you?

How do you feel and function most mornings?

How would you like to feel and function in the morning?

Please describe your morning routine.

Please describe your experience with Yoga Nidra (If you're brand new, welcome!)

How do you "view" napping or taking moments to rest? What does that look like for you?

Describe in detail. Example: "I take naps, this is my nap routing when I get of shift.... " or "I was taught naps are lazy so I have never done them" or "naps are foreign to my lifestyle" or "I love naps!" "I wish I knew how" or "Who needs naps" or "I just drank espresso, what's a nap?" or "The only naps in my household are my kindergartner's" or "I love the concept of naps, however I live a busy lifestyle and rarely get to experience rest" "I don't nap....but I scroll tik tok..."

Please describe the quality of your sleep

examples: light sleeper, out like a rock, tossing and turning, I experience sleep apnea (cessation of breathing), I'm told I snore like a chain saw, I sleep like sleeping beauty, I wake up frequently between midnight - 6 am randomly or to pee, medication influences or alters my natural sleep.

Please describe your experience with breath practices (and if you have had any first hand experience with any techniques, share what worked and what didn't work for you)

Please describe what you know about trauma sensitive breath practices (and if you have had any first hand experience with any techniques, share what worked and what didn't work for you)

Our nervous systems have various branches and functions. Our behaviors, lifestyles and dietary choices influence the tone and function of our nervous system. Describe your lifestyle, and if you can describe what you notice about your nervous system. Does your nervous system tend to get overly activated or is it balanced? How do you notice symptoms in your body that cue you that your nervous system is in a certain state? Without going into the story of your life, be specific about the tone and patterns of your nervous system.

Describe in as best detail as possible.

Our final question(s) have less to do with training concepts and more to do with helping us to get to know you! It's also a great opportunity for you to self reflect in exploring these questions. Take a moment to contemplate about what or who inspires you, your hobbies and passions. Share what motivates you, what drives you and what inspires you in life.

Be authentic in your response :) Thank you for completing this form, it is helpful for our planning purposes! 1. My greatest passion in life for pleasure is (examples: welding, building things, hiking in nature, fishing, surfing, dancing, traveling, bowling, reading or XYZ) _________________________________ 2. What inspires me me most in life is (think about that which makes you feel alive, and light up, that which gives you an internal urge to do something or be a a certain of person): _________________________________ 3. If I was to name my life purpose it would be (it doesn't have to be career related, it can be a quality for example, Sean's a firefighter, but his true purpose in life is to support people. I specialize in sleep, however I believe my purpose in life is to bring joy and empowerment to people, these are just examples, find your own. Everyone's response will be unique to themselves): _________________________________ 4. My all time favorite / inspirational quote is: _________________________________ 5. The person / experience / belief system / XYZ that I value most in life is : _________________________________

Is there anything we should know that would help us provide you an optimal learning experience?

(Please list if you have been diagnosed with a mental health condition such as PTSD, anxiety or depression, any sleep disorder such as sleep apnea or insomnia, and any acute or chronic injuries, mental or physical, and or any food allergy that we should be aware of. This information is kept confidential.)

Food Preferences & Allergies

If you marked other or have anything else we should know about your food preferences so we can communicate that to the Joyful Journeys kitchen staff, please describe.

First Responder Sleep Recovery Train the Trainer Liability Form & Waiver

Please mark that you've read and agreed to the following:

I am in agreement that I will be respectful to all train the trainer participants, staff as well as abide by the policies and rules of Joyful Journey’s and their staff. I understand alcohol and substances are not allowed on the premises. If I do not adhere to the rules I understand that I may be removed from the program and premises without any refund.

I am in agreement that I will not film, record, reproduce, distribute or sell any of the provided materials in this training to any person without written permission from Jacqueline Toomey.

I agree to respect the privacy of other participants and keep all conversations in confidentiality.

I understand and agree that in the First Responder Sleep Recovery Teacher Training, I am participating in yoga classes, health programs, workshops and/or other wellness, body work, acudetox, sound therapy, exercise and healing arts activities and I release all members affiliated with AXS Wellness LLC. and hold them harmless. I understand that the topic of studying trauma may be innately challenging and I am of sound mind to participate. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. In this agreement, I acknowledge that participation in yoga classes exposes me to a possible risk of personal injury. I am fully aware of this risk. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident and/or illness during any yoga class. I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows: I (a) irrevocably WAIVE, RELEASE AND DISCHARGE FROM ANY AND ALL LIABILITY for my death, disability, personal injury, property damage, property theft or actions of any kind which hereafter may occur to me, including my traveling to and from Joyful Journeys, who is hosting this training and where sessions are being held, and each of the directors, officers, employees, volunteers, representatives and agents of AXS Wellness LLC.; and (b) INDEMNIFY, HOLD HARMLESS AND AGREE NOT TO SUE the entities or persons mentioned in this paragraph as to any and all liabilities or claims made as a result of participation in the workshop, yoga or wellness classes, whether caused by the negligence of releasees or otherwise. My agreement further acknowledges that I shall not now or at any time in the future bring any legal action against Teacher and/or AXS Wellness LLC,; and that this waiver is binding on me, my heirs, my spouse, my children, my legal representatives, my successors and my assigns. This agreement verifies that I am physically fit to participate in yoga classes and hiking in nature, and a licensed medical doctor has verified my physical condition for participation in this type of wellness training. By registering, I am in agreement and understanding of this liability waiver to participate in the Train the Trainer April 6 - June 7 2024 both online and at at Joyful Journeys, in Moffat, Colorado.

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