Registration and Waiver Form for the Bilateral Stimulation Healing Birth Trauma Series

Contract: 

I understand and agree that:

8 weekly one hour sessions, if I am taking this course as a 1-1 or the 8 weekly one hour and a half  hour sessions if I am taking this course as a circle, will be interactive, zoom classes on the Bilateral Stimulation Healing Birth Trauma Model, developed and taught by Gena McCarthy RN, MFT#32708, and will be what I will receive when I agree to take this program.

Dates will be arranged between students and instructor.

Upon Registration and payment, I will recieve the link for these classes.

I will receive 8 CEs through CAMFT Provider Gena McCarthy, if I attend each session live whether individually or as a member of a circle class.  Recordings will not be a substitute for CEs. CAMFT approved 1 CE for each hour of Course. Only applicabe for California therapists.

Total Fee:

If I organize a committed circle of 6 people or more: $500 for Entire Series of modules and sessions, Including:
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6 people or more registered with fee of $1600 each or $200/ session
I coordinate time of training with Gena McCarthy and them.

For Individual sessions: Fee: $250/session or $1800 up front a $200 discount.

My payment committment is for the full 8 weeks whether I attend or miss a live session. For Individuals if sessions need to be rescheduled this may be an option and is available for 2 sessions upon discretion of the teacher. Recordings will be sent for missed sesssions.

Learning Objectives: 

1 - Participants will be able to demonstrate bilateral stimulation tapping practices for somatic resourcing and bilateral stimulation tapping practices for processing and be able to explain the difference.

2 - Participants will be able to describe the structure of the Healing Birth Trauma Bilateral Stimulation Model, developed by Gena McCarthy RN, MFT. They will be able to list 2 different rationales for using this structure.

3 - Participants will be able to list and apply at least 3 differrent interweaves to apply to clients when they feel stuck.

4 - Participants will be able to list 3 examples of health care personnel behaviors, interventions and communications that are disrespectful and harmful to birthing mothers.

5 - Participants will be able to list 3 client history questions releveant to identifying what is hooking their client.

 

Waiver:

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.
 
Healing Birth Trauma Work can bring up strong emotions.
 
By signing this form 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 course.  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.
 

REFUND AND CANCELLATION POLICY: NO REFUNDS. CANCELLATION NA

SPECIAL ACCOMMODATIONS: EMAIL GENAMCCARTHY3@GMAIL.COM

TO OBTAIN THE GRIEVANCE POLICY OR REPORT A GRIEVANCE PLEASE EMAILGENAMCCARTHY3@GMAIL.COM OR CALL 510-685-6827

COURSE COMPLETION CERTIFICATES WILL BE AWARDED AT THE END OF THE COURSE IN EXCHANGE FOR RETURNED EVALUATION FORMS. COURSE MEETS THE QUALIFICATIONS FOR 6 HOURS OF CONTINUING EDUCATION CREDIT FOR LMFT’S, LCSW’S, LPCC’S AND LEP’S AS REQUIRED BY THE CALIFORNIA BOARD OF BEHAVIORAL SCIENCES

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