Course Registration Form

A Journey to Reclaim Ancestral Wisdom Application

This is the registration form for those who are interested in joining the 10-week Online Journey, "A Journey to Reclaim Ancestral Wisdom". This program starts on September 11th and ends on November 13th. We will meet online using Zoom each Monday from 7pm - 9pm EST.Once you submit your registration for the program, you will receive a confirmation email that will also include the link to make payments. A non-refundable $100 deposit will be needed within 48 hours of receiving the confirmation email in order to reserve your space. Please take your time answering the questions on this form. Should you have any questions, please feel free to email us. We look forward to facilitating this transformational space for you and your ancestors!
Name*

First NameMiddle NameLast Name
Email*
example@example.com
Mobile Number*
We are offering this program on a sliding scale of $500-900 + processing fee to make it accessible for folks with different financial situations. We are also providing payment plans, broken down into 3 payments. Please know that for each payment there is also a processing fee of 3% that Stripe charges. Do you need a payment plan setup?
Please indicate what you are committing to pay for the program*

$500 + 3% processing fee$600 + 3% processing fee$700 + 3% processing fee$800 + 3% processing fee$900 + 3% processing fee
Birth Date

MonthDayYear
What is your preferred pronoun(s)?
Where are you located?*
What is the main reason that you feel called to join our program?*
Have you done ancestral healing work? If so, what experiences do you have?*
Do you know who your ancestors are? (where they come from, stories, etc.)*
What are you intentions for this journey? What are you hoping to get out of it?*
Do you have any healing practices that can help support your integration throughout this journey?*
Are you familiar with Family Systems Work?*
Have you ever participated in therapy? What worked for you? What didn't work?*
How comfortable are you with speaking within a group setting? Anything we should know to better support your journey?*
Are you familiar with using Zoom?*
Do you have any fears, hesitations, reservations about this journey? (it's ok if you do!)*
In our first group session, we will come up with a list of community agreements for how we will co-create the space together. The intention in doing this is to find a way to make the space welcoming for all to participate. Will you uphold the agreements we come up with?*
Is there anything else you wish to share with us ahead of our first time meeting?
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A Journey to Reclaim Ancestral Wisdom Application