201808 The Couple Relationship Registration Form
Please fill out this form and include your payment to reserve your spot.
Registration for the course includes filling out this form and your payment.
The information in this registration form is kept strictly confidential.
Your E-mail address:
How did you hear about this course?
Where in the world will you be for the course?
Have you done any family constellations or attended workshops before?
How will you be paying? Please choose one.
RELEASE OF LIABILITY: I take full responsibility for my experience. I understand that I may leave these meetings at any time for any reason. I understand that this workshop may bring up issues of a highly personal nature that may cause me to experience emotional or physical responses that may be unexpected and/or unpleasant. Further, I understand that I may experience mental, emotional, physical, or spiritual distress and that such distress may cause unpleasant feelings. What is experienced in this workshop/training may create physical responses on my part or on the part of other participants. I understand that there is the risk of accident, injury, and emotional distress. I agree to assume this risk, including but not limited to the types of responses described. I confirm that I do not suffer from any mental or physical impairment, and have not been diagnosed at any point with a disorder, condition, or injury, either physical or mental, that might make it inadvisable for me to assume such risks. This workshop is designed as an educational venue only. This workshop is not designed as a substitute for therapy or as a substitute for any other form of professional consultation. By clicking below, I willingly agree to the preceding statements and to hold harmless from all liability, the facilitator, the organizers, and all participants attending this course.
I have read and agree to the terms of this course.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service