-
$0
Total
-
Participant Information
-
Name *
-
-
Address *
-
Phone *
-
-
-
-
Registration Agreement and Workshop Information
I understand and agree that:
The 2 day Workshop: Models and Elements of Effective Perinatal Trauma Treatment Workshop.
CEs: Dona and Meac available
Payment for 2 day workshop is $350.
When you submit this form, you will directed to paypal to complete your payment or will be contacted for invoice payments. Your registration is not valid until payment is received.
• Course purchase is non-refundable. You may gift or sell your space if you are unable to attend.
Payment Plan options:
My payment commitment is for 2 Day Workshop.
I agree to keep any personal material of any member completely confidential.
This workshop can be taken by itself or as part of the requirements for the Birth Spirituality and Healing Coach Certification as long as prerequisites have been taken: This Workshop is required for Birth Spirituality and Healing Coach Certification program. More information about the coach program can be found on online at www.birthspiritualityandhealing.com
-
-
*
-
Name *
-
Date *
/
/
-
-
Consent and Release of Liability
This is a general release form for services related to the Birth Spirituality and Healing Coach Program Part I, Perinatal Wellness and Trauma Prevention Practices Workshop.
By signing this document, the participant agrees to release Gena McCarthy RN MFT#32708, from any liability, real or perceived, as a result of services received.
Birth Spirituality and Healing growth work can bring up strong emotions.
By signing this document the participant is stating the she feels stable and mentally and physically prepared to handle these emotions if and as they arise. Though the program is full of resourcing practices and designed to support participants to feel safe, 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 Gena McCarthy RN, MFT#32708 and would entail a separate payment agreement than this agreement. By signing this form the participant agrees that Gena McCarthy MFT#32708 is not liable for any pain or emotional distress that may ensue in the course of this work.
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 even of my death or incapacity.
-
*
-
Name *
-
Date *
/
/
-
-