Application
Our goal is to create a supportive, collaborative, and safe environment where participants can engage fully in their learning process. When you complete and sign this document, you agree to respect the guidelines set by the instructors, and to engage in the spirit of curiousity and mutual learning. While we recognize and honor the vast skills and experience you bring, we ask that you approach this workshop as an opportunity to learn and explore the approaches being introduced. At the end of this form, you will be asked to e-sign the form, accepting the terms of participation, inculding our cancellation policy, and agreeing to maintain professional conduct throughout the workshop. Please be aware that this class is limited in size and if you are not accepted we will put you on the list for future workshops.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have any physical or health conditions we need to be aware of?
In the case of an emergency, whom can we contact?
*
Emergency contact phone number
*
What are your goals or intentions for attending this workshop?
I agree to attend the workshop and maintain professional conduct throughout the event.
*
Agree
Disagree
I agree to arrive on time and stay through the completion of the workshop.
*
Agree
Disagree
I certify that I have not been arrested or convicted of any crimes, nor have I been called out for sexual misconduct.
*
Agree
Disagree
I understand that payments must be made and completed before the start of the workshop.
*
Agree
Disagree
I acknowledge that this agreement is legally binding and that I have read and understood all terms outlined herein.
*
Agree
Disagree
By signing your name below, you certify that this electronic signature is legally binding and holds the same validity as your handwritten signature on this document.
*
Date
*
-
Month
-
Day
Year
Date
Submit
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