2022-2023 5-Day Immersion Registration & Deposit

Contact Information:

Name*

First NameLast Name

Email*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Best phone to reach you*

Best number to reach youFormat: (000) 000-0000.

Emergency contact*

First and Last Name

Emergency Contact Phone*

Area code and phone numberFormat: (000) 000-0000.

Relation*

Relationship

Registration and Payment

Dates: October 4-8, 2023

Days: Wednesday-Sunday

Meeting time: 9:30am-6:00pm daily. Sunday's class may complete earlier than 6:00pm, depending on the group's needs.

Tuition: $1850 - $925 deposit due upon registration; $925 due on August 21, 2023, 45 days prior to the first day of the Immersion.

PaypalCheck

My Products*

October 4-8, 2023 Deposit$925.00

Total $0.00

October 4-8, 2023 - $925 deposit

Total Amount to Mail:

Instructions for paying by check:

Please make your check payable to Healing Arts of Belmont and mail it to:

Jamy Faust
Healing Arts of Belmont
750 Pleasant Street
Belmont, MA 02478

We will confirm receipt.

How did you learn about the Constellation Approach™ 5-Day Immersions?*

Questions

All answers are confidential.

Please answer even if you have registered in previous years. They offer a chance to look at where you are now and what you'd like to achieve this year.

What kinds of depth work such as private psychotherapy, schools or programs attended, courses or studies related to your own personal growth have you experienced?*

Please give us a brief description of your family of origin and current family.*

Do you take prescription medications for psychological reasons, such as mood stabilizers, anti- depressants, or the like? What are they and for how long have you taken them? Your answer has no affect on your acceptance into the program.*

Policies

Course Completion:

Each 5-Day Immersion is designed to guide your healing through three powerful modalities - Family Constellations, Energy Medicine, and the Awareness of Soul Nature - the core tenets of The Constellation Approach™. During a 5-Day Immersion, we’ll teach the philosophy that underpins TCA™, facilitate individual constellations, group constellations, direct constellations, offer guided meditations, moderate sharing rounds and provide many opportunities for learning.

If you miss a day or days, (a) it is your responsibility to ask your classmates for the covered information, and (b) it is recommended that you schedule a private session regarding the missed theme with Peter at his current Private Session fees. There are no pro-rated rates for missed days.

Cancellation Policy:

Cancellations will incur a one-time $200 cancellation fee.

o There will be no refunds for cancellations received after 45 days before the start of the 5-Day Immersion.

o Payments are non-transferable to others or to future dates.

o There are no price reductions for unattended days.

o Emergency cancellations are considered upon personal contact with Jamy or Peter.

Agreements:

It should be understood that the 5-Day Immersions in The Constellation Approach™ are not designed as a substitute for professional consultation or therapy where indicated. The 5-Day Immersions in The Constellation Approach™ are for educational purposes only. I understand that these 5-Day Immersions 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.

The Constellation Approach™ reserves the right to postpone, cancel or change the program schedule in the event of unforeseen and unavoidable circumstances.

The Constellation Approach™ is not responsible for student’s travel, lodging or incidental expenses.The Constellation Approach™ will do everything possible to reschedule the program to accommodate as many people as possible. The Constellation Approach™ is not responsible for student’s travel, lodging or incidental expenses.

I willingly agree to hold harmless and release from all liability the organizers, facilitators, and participants of the 5-Day Immersions in The Constellation Approach™ and associated workshops.
I agree to respect the confidentiality of the participants within the course of this program.
I will not discuss anyone’s personal process outside the meeting space.
I agree to the payment method that I have selected and agree to pay all monies associated with that agreement.
I understand and agree to the cancellation policy listed above.

With my initials below, I give my permission to share my emal address with other participants in the 5-Day Immersion on a class list. This class list is confidential and for use only as part of the Immersion classes:*

Your intials here

Signature*

By digitally typing your name above, you agree that this is valid as your signature.

Date*

MonthDayYear

Thank you!