Healing Birth Circle Registration Form

A day-long circle to bring healing to your experience of a traumatic pregnancy, birth or postpartum period.

What: This is an experiential and participatory workshop for mothers and birthing people who want to process a difficult birth with the support of knowledgeable therapists and a compassionate community. We provide education and support, and share resourcing practices – including a healing-birth-trauma-specific bilateral stimulation model, designed to reduce triggers and alleviate suffering. We will also share journaling prompts, guided mediations, and expressive art exercises. We hope that you will leave the workshop understanding your journey more deeply, and be able to hold the impacts of difficult childbirth(s) on your mind, body and soul with more ease and self compassion. This workshop is designed to continually resource you to feel safe, supported and grounded as challenging emotions arise. This work is a model developed by Gena McCarthy, RN, LMFT, and Perinatal Ceremonialist.

**While bilateral stimulation models do not provide the same scope as EMDR, this model makes use of some of the same methods. 

When: Saturday September 19th 10am-4pm

For who: Birthing people who feel they need support processing difficult childbirth(s), labor and delivery experiences, and challenging beginnings to parenthood. This workshop is designed to be attended without children. Those who are currently pregnant are welcome.

By who: Sarah Connolly AMFT #145129 (Supervised by Macy Schoenthaler, LMFT #86214)  and Meredith Isaksen AMFT #151125 (Supervised by Laura Rose LMFT #83808)

Where: East Bay Birth Collective 6333 Telegraph Ave #103, Oakland

Cost: The cost is $250. 

Registration: Please complete this google form to express your interest in registering for the circle. You will then receive a 15-20 minute call to let you know what happens in the circle, learn more about what is calling you to the circle, and answer any other questions you might have. Your registration will be confirmed and you will be billed via Venmo after the pre-workshop phone call. 


Contact us:
Sarah Connolly AMFT #145129, (510) 696-0504, sconnolly@axismunditherapy.org
Meredith Isaksen AMFT #151125, (510) 296-9293, meredithisaksen@gmail.com 
Sign in to Google to save your progress. Learn more
Name *
Email  *
Phone Number *
I understand that I will have to pay $200 via Venmo. Please share Venmo handle below. *

Consent and Release of Liability for Healing Birth Circles 

This is a general release form for  Healing Birth Circles.

By signing this document, the participant agrees to release Sarah Connolly, AMFT and Meredith Isaksen, AMFT from any liability, real or perceived, as a result of services received. 

Healing  Birth work can bring up strong emotions, as such it is our policy that children should not be in attendance. This circle is designed to continually resource the participants so they feel safe, supported and grounded as these emotions arise.

By signing this document the participant is stating they feel stable and mentally and physically prepared to handle these emotions if and as they arise. It is also understood that the participant agrees she will seek medical, psychiatric or therapeutic help if the need arises. This help may include the services of the facilitator of this circle and would entail a separate payment agreement other than this circle agreement. By signing this form the participant agrees that Sarah Connolly, AMFT and Meredith Isaksen, AMFT are not liable for any pain or emotional distress that may ensue in the course of this work. 

With regard to confidentiality -- all that is shared in this circle, stays in this circle. Confidentiality enables vulnerability and the depth of our group process. Be aware of and take care with dual relationships.

By signing this form, the participant agrees that any dispute arising out of this agreement or the services provided under this agreement will be resolved by arbitration with an agreed upon arbitration provider. 

I acknowledge that I have read this agreement, that I have executed this agreement voluntarily, and that this agreement is binding upon myself, my heirs, executors, administrators and representatives, in the event of my death or incapacity.

**To sign and agree to this consent and release from liability, please type your name in the short answer text space below. *
Cancellation and Refund Policy

Cancellations made more than 14 days before the session start date are eligible for a refund, minus a 15% non-refundable booking fee. Cancellations made within 14 days of the session start date are not guaranteed a refund. However, if we are able to fill your spot, we will refund your payment minus the 15% booking fee.
 *
Required
Where did you hear about the circle? *
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

Google Forms