Book Club Consent

Please complete this form in full. Once it's complete, I will send you a payment link via email (If you don't receive a payment link via email after 24 hours, please email me: illuminatedencounters@gmail.com).

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

TERMS AND CONDITIONS

By signing this form and attending the event, you agree to the following:

Confidentiality: You may share your own experience with others outside of the book club, but what others share and the identity of others will be kept confidential.
Respect: I reserve the right to refuse service or terminate immediately if you threaten, bully or berate group members or myself.
Suitability: While often supportive, this guided book club is not a substitute for therapy or counseling services. This group is not a clinical service and is not intended as mental health counseling or crisis management services. In attending this event, you agree not to use the group for mental health or crisis support. I reserve the right to refuse or cease services if I believe you exceed the level of support offered in this setting.
Reading materials: You are responsible for purchasing your own book. I suggest Orca Books Cooperative, Barnes and Noble or indiebound.org.
Covid and other communicable illnesses: You agree to wear a K95 (or above) mask while on site. I will have extras available if needed. The room will have an air purifier running at all times. If you are physically ill or have been exposed to someone who is ill, you agree to stay home. The group size is limited to reduce exposure.
Attendance: You are asked to attend all sessions whenever possible. I realize that circumstances may be out of your control, however you are responsible for paying the full price of the session whether you are present or not. These sessions are not prorated.
Therapy clients: This group is not open to current or former therapy clients. Sorry!

By signing this document, you signify that you understand and consent to these terms and conditions. You also consent to be added to my email list. You can unsubscribe at any time.

Signature

Which fee is appropriate for your need? (I don't require proof; I trust you.) I might suggest looking at the "Green Bottle" method to help determine your fee: https://www.wortsandcunning.com/blog/sliding-scale

Standard fee: $320 for full seriesReduced fee: $160 for full series (1/2 price)Expendable income fee: $400 for full series