Lighten Up & Be
Host Lighten Up Juice Cleanse
Lighten Up Application
Shareshten's Yoga Schedule
Lighten Up® - 5 Day Juice & Chakra Cleanse Application
*This form is to help Shareshten determine if this experience is right for you at this time.
This will enable her to better serve you individually during the cleanse experience, and to accommodate your specific needs. Thank you for taking the time. This information will only be read by Shareshten and will be kept completely confidential, whether
you go through with the cleanse or not.
After Shareshten reviews your completed application, she will be in touch.
Please allow 48 hours for a response.
You can reserve your spot or pay your full tuition before or after submitting your application here:
Reserve your spot with a deposit or pay the full tuition.
Indicates required field
Are you interested in learning more about on-site lodging?
Have you ever done a juice-cleanse before?
If Other, please specify:
What is your age?
Less than 13
Prefer not to say
What is your current daily diet?
Meat, no grain, Paleo
Vegetarian with eggs and cheese
Vegetarian, no eggs
Gluten Free with limited meat
Gluten Free Vegetarian
Gluten Free Vegan
If Other, Please specify:
What is your relationship with food? Have you ever had an eating disorder? How have you learned to nourish yourself better over the years?
Please list your current Drs. names:
What is the number one concern about this experience for you personally?
Have you ever been hospitalized?
If Yes, Please Explain
List all instances with brief description of procedure and outcome.
Check the statement that most Resonates with your interest in Lighten Up® Juice & Chakra Cleanse. I want to...
Become more aware of my energy body.
Deepen my asana practice & be happier and freer from suffering throughout my year.
Alkalize my body.
Help my bones, joints, deeper connective tissues.
All of the above
Let go of the world and have my own experience. I have no expectations. Bring it on.
None of the Above
If none of the above, what is your intention for the juice cleanse?
How can we best support you in the decision to join us on the upcoming LightenUp Juice Cleanse?
Phone Call Consultation
Email me with pictures & testimonials
If Other, Please specify here:
You can reserve your spot with a deposit or pay your full tuition before or after submitting your application here:
Pay Your Deposit or Full-Tuition
Classes & Workshops