The Healing Haven Community Application

PROGRAM APPLICATION
Thank you for your interest in The Healing Haven Community 12-Week Trauma & Relationship Reset Program.

This application helps us understand your goals and determine if the program is the right fit for you.

The Healing Haven Community is designed for individuals who are ready to take accountability for their healing journey and participate in a structured growth process.

Please answer the following questions honestly and thoughtfully.

Intake Form:

Personal Information:

Name

First NameLast Name

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Method Of Communication

Do you have access to this number and phone at all times?

How did you hear about The Healing Haven Community?

What made you interested in joining The Healing Haven Community?

What emotional or relationship patterns are you currently trying to break or improve?

Which areas of your life would you most like to grow in during this program?

The Healing Haven Community is designed for individuals who are ready to take accountability for their healing journey. Because seats in each cohort are limited, we ask applicants to seriously consider their level of readiness before applying. If accepted into the program, how likely are you to move forward and secure your seat?

Have you participated in any personal development, healing, or coaching programs before?

If yes, please briefly describe your experience.

What would success look like for you at the end of this 12-week program?

The Healing Haven program requires weekly participation, reflection work, homework assignments, and emotional accountability. Are you prepared to commit to the full 12-week experience?

Are you willing to participate respectfully in group discussions and respect the privacy of other participants?

Do you understand that personal growth and healing may involve uncomfortable conversations and self-reflection?

Which cohort are you applying for?

The Healing Haven program tuition is $2,000. An Early Bird rate of $1,800 ($200 off) is available during the Early Bird enrollment period. A deposit is required to secure your seat. Early Bird Deposit: $350 Standard Deposit: $500 How are you planning to enroll?

Why do you believe this is the right time in your life to commit to this program?

APPLICANT ACKNOWLEDGEMENT
By submitting this application, I acknowledge that:

• The Healing Haven Community is a structured personal development program.
• Participation requires honesty, accountability, and active engagement.
• Enrollment is confirmed once the coaching agreement is signed and the required deposit is submitted.

Please sign if you understand and agree

NEXT STEP MESSAGE (AFTER SUBMISSION)
Thank you for submitting your application.

Once your application is reviewed, you will receive the coaching agreement and deposit link to secure your seat.

• The Client Coaching Agreement
• The Deposit Payment Link to secure your seat

Seats are limited and enrollment is confirmed once both the agreement and deposit are completed.

The Healing Haven Community — Application