Request edit access
Join The Resilient Mamas Forest
Thank you for joining our forest! This form will serve as your registration for the March Group: Finding Me Again: Regaining a Sense of Identity After Motherhood. Upon completion of this form and payment via Paypal or your preferred payment method your membership will be considered active. Membership will be active for March 1-31st, 2019. Please contact rachel@resilientmamas.org if you would like to an alternate payment method to Paypal and you will receive an invoice. Membership includes addition to the exclusive Facebook group for the monthly circle which includes access to weekly online videos and social support with other mothers, weekly e-mails with inspiration and challenges ,and the ebook Finding Me Again: Regaining a Sense of Identity After Motherhood by Rachel Bowers LISW-S, meant as a guide to follow along through the month with meditations, weekly exercises, and worksheets.
Email address *
Name
Your answer
Street Address, City, State, and Zip Code
Your answer
Phone Number
Your answer
Were you referred to the Forest Circle by a friend who was a member? Please put her name here.
Your answer
Are you on Facebook? If so, please write the name of your profile if different than your name above. This will ensure that we approve your request to join the group.
Your answer
Click on the following link below and click "Join group" to join our Forest Circle. You will be entered into the group upon receipt of payment.
Select Payment Method
By entering your name below you are agreeing to our disclaimer and the terms and conditions of your registration and involvement in Resilient Mamas Coaching Services. Terms. Membership in the Resilient Mamas Forest Circle is for a period of 30 days. Membership includes a digital workbook based on the month's topics, weekly e-mail with references to the exercises for the week, and membership to the Facebook group exclusive to that month's topic where you can engage with other members and engage in live videos covering the month's topic. Membership benefits do not begin until payment has been made. No refunds are offered after payment. You are responsible for renewing your membership for the next month's topic by making a new monthly payment. As membership is month to month there is no need to cancel. All information obtained for membership purposes is kept confidential. Your information is not sold to third parties. Disclaimer: By participating in Resilient Mama Coaching Services I acknowledge that I am not receiving psychotherapy services and that coaching services are not intended to diagnose, treat, or cure any mental health conditions. I may be offered screening for mental health conditions by request and given referrals through this service but claim responsibility for securing my own mental health services if needed. I understand that outcomes of coaching services can not be guaranteed. I understand that any personal information shared with my coach is kept confidential with the exceptions of limits of confidentiality. I understand that if I make statements that inform my coach of known child or elder abuse, or that I am a risk to harm myself, another individual, or that I am at risk of being harmed by someone else that appropriate authorities and service agencies may have to be notified by my coach due to state mandated reporting regulations. I commit to keeping confidentiality of my fellow group members person information in terms of what is shared in the Forest Circle Facebook group and weekly chats. I understand that I am sharing any personal information at my own risk within the Facebook support group and that any information provided on Facebook may not be protected. I am aware that any deliberate and harmful breaking of confidentiality may result in my removal from the Forest Circle. I acknowledge that I am participating voluntarily coaching services and that I am solely and personally responsible for my choices, actions and results, now and in the future. I accept full responsibility for the consequences of my use, or non-use, of any information provided on or through Resilient Mamas website, support group, and coaching services and I agree to use my own judgment and due diligence before implementing any idea, suggestion or recommendation from services to my life.
Your answer
Thank you and Welcome!
Thank you for competing your registration. You will receive an e-mail upon registration and payment with your digital workbook, pertinent links and information within 5 days prior to March 1st.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service