Participant Release Form
Please Note: The Building a Lasting Connection™ Workshop is a psychoeducational resource for relationship couples, newly married couples, and couples in long-term committed relationships interested in enhancing the bonding process of a newly formed relationship and the present and future quality of their relationship. This program is not intended to be a substitute for marital therapy with a licensed processional therapist.

If you or your partner are experiencing significant relationships distress, severe anxiety or depression, or any other mental health issue, you are urged to seek treatment from a professional immediately. This program may serve as a supplemental treatment option under the care of a licensed mental health professional.

*I understand this relationship group program is designed to assist me in understanding my relationship and provide guidelines for enhancing the present and future quality of my relationship. I understand that I am fully and solely responsible for the results and decisions I make regarding my use of the content of this program. I release the facilitator/s, the program developer, and all related institutions and organizations from any and all responsibility or promise and accept full responsibility for any change or decision now or ever made regarding my involvement in this program and use of any related materials. I also understand that this is a psychoeducational program, not couple therapy, and the facilitator may not be trained in any therapy model and is not acting as a professional counselor.

A copy of your responses will be emailed to the address you provided.

Sign in to Google to save your progress. Learn more
Email *
I have read and understand the contents of this Participant Release Form, and I agree to be fully bound by it by entering my full legal name as my digital signature below. *
Date *
Attending with (partner's name) *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy