FLOURISH

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

FLOURISH

Women's Art & Mindfulness Group with Jena Leake, Ph.D., R.E.A.T.
Mondays, April 29 - June 10, 2019 (6-weeks, no group May 27), 6:30 - 9 pm
Sacred Plant Traditions

Name *

Address *

Email *

Phone *

Birth Date *

Emergency Contact Name & Phone Number *

Please write a brief description about what you hope to experience in this group, as well as anything you would like the facilitator to know: *

Please note the following class policies: A deposit of the full fee is required to reserve your place. A 50% refund is available if cancellation is made 3-weeks prior to the start date of the class. Refunds will not be available after this time. However, if you need to cancel, you may gift your reserved place to a friend. As a courtesy to the facilitator and all group participants, please plan to arrive on time for each class and stay for the duration of each group. If you plan to miss a session, please contact Jena prior to the class. Please be advised: Groups are offered for personal growth and creative development and not for individual or group therapy.The facilitator, Jena Leake, and the group location, Sacred Plant Traditions, are not responsible for any personal injury or loss of property. Some art materials are included in fee; a short materials list will be provided upon registration. Please confirm that you have read and agree to the group and payment policies. *

Yes

Required

Please select payment method *

I have paid on-line through PayPal

I am sending a check made payable to Jena Leake at the following address: 805 2nd Street NE, Charlottesville, VA 22902

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms