Self-Management Awareness Workshop Form
Awareness Workshops are provided by Futuristic Super Learning Pvt. Ltd. / Futuristic Learning U.S.A.
www.futuristiclearning.com 

Pakistan +92-321-3894095

Sign in to Google to save your progress. Learn more
Confidentiality – Your Right to Privacy

All information you share with us is kept strictly confidential. 

If you are under the age of 18, please have a guardian fill out this form on your behalf.

Reference? Where did you hear about us? 
 *
Full Name *
Cell Phone Number
 *
Email *
Home Address *
City of Residence
 *
Date of Birth (DOB)
 *
MM
/
DD
/
YYYY
Are you a student or a working professional? *
What is your current occupation? Profession & Designation? *
Organization / Company / Institute
 *
Education
Please select which applies to you.
 *
Are you on any medications? If yes please describe
 *
DISCLAIMER AND CONFIDENTIALITY AGREEMENT (PLEASE READ) 
User Agreement

By enrolling in any of Futuristic Super Learning Pvt. Ltd. / Futuristic Learning's courses, workshops and/or refresher sessions, you are granted a nonexclusive, nontransferable, revocable access to our copyrighted course content and any associated materials ONLY for your own personal and non-commercial use. The copying, redistribution, use or publication by you of any of the content within our courses is strictly prohibited. Your enrollment in our courses, workshops, and/or refresher sessions, does NOT grant you any ownership rights and does NOT grant you license to train our courses or contents of our courses to others. Any breach in the terms of this agreement will result in legal actions.

 *
Required
Medical Notice

You agree that none of the courses provided by Futuristic Super Learning Pvt. Ltd. / Futuristic Learning, should be used for any diagnosis or treatment of any condition or disease. If you are currently being treated by a physician or other healthcare practitioner for any condition or disease, please consult with that provider prior to changing or modifying any treatment program.

You agree that Futuristic Super Learning Pvt. Ltd. / Futuristic Learning DOES NOT intend to diagnose nor prescribe for any medical or psychological conditions nor claims to prevent, treat, or cure such conditions.

You agree that Futuristic Super Learning Pvt. Ltd. / Futuristic Learning DOES NOT intend to replace a one-on-one relationship with a doctor or health care professional and any given information during the training is not intended as medical advice and SHOULD NOT be used as a substitute for professional diagnosis and treatment.

You agree that Futuristic Super Learning Pvt. Ltd. / Futuristic Learning expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of my reliance on the given information.

 *
Required

Event Photography

By attending our courses, workshops or refresher sessions, you acknowledge that photographs and audio/video footage will be taken, and that your image and likeness may be used by Futuristic Super Learning Pvt. Ltd. / Futuristic Learning for on our website and on social media platforms.

 *
Required
Do you agree with the above disclaimer, if yes, please select 'AGREE' and submit the form. If you 'DISAGREE' please speak with our team member before submitting the form. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Futuristic Learning.

Does this form look suspicious? Report

Google Forms