Course Registration Form

Dear God – 5-Week Online Course Registration

A faith-centered online journey for women and moms seeking deeper connection, clarity, and growth with God.
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number
Payment Option (Founders Birthday Special – $100 total)

Pay in Full: $100 todayPay in Full: $100 today$20/week for 5 weeks
Waiver, Liability & Participation Agreement

Please read carefully before submitting your registration.By registering for Dear God – 5-Week Online Course, I acknowledge and agree to the following:
1️⃣ Voluntary Participation

I understand that my participation in this online course is completely voluntary. The course includes faith-based teaching, prayer, reflection, group discussion, and encouragement.

2️⃣ Not a Substitute for Professional Services

I acknowledge that Dear God is a faith-based, educational, and supportive experience only and is not a substitute for medical care, mental health therapy, counseling, legal advice, or professional services of any kind.

I understand that I am responsible for my own well-being and decisions throughout the course.

3️⃣ Limitation of Liability

I agree to release and hold harmless Kelita’s Farm A Sea LLC, its founder, facilitators, partners, and volunteers from any and all claims, liabilities, or damages arising from my participation in this online course.

4️⃣ Confidentiality & Respect

I agree to respect the privacy and confidentiality of other participants. What is shared in the group is to remain within the group. This is a safe, respectful, and faith-centered space.
Payment & Spot Reservation Acknowledgment

I understand and acknowledge that:My spot in the Dear God – 5-Week Online Course is reserved only once payment is receivedI will receive a separate email with an invoice or payment instructionsFailure to submit payment may result in my spot being released
Course Materials & Book Acknowledgment

I understand that course participation may reference the Dear God book.If I have not already purchased the book, I may do so on Amazon using the following link:👉 https://amzn.to/4qEp3si(Book purchase is recommended but not required unless otherwise stated.)
Agreement & Consent

By submitting this form, I confirm that:I have read and understand this Waiver & Liability AgreementI agree to the terms aboveI am participating willingly and with full understanding
I agree to the Waiver & Liability Agreement

Yes I agree
How can we pray for you during this journey?
(Optional — you may share as much or as little as you’d like)
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Dear God – 5-Week Online Course Registration

Waiver, Liability & Participation Agreement

Payment & Spot Reservation Acknowledgment

Course Materials & Book Acknowledgment

Agreement & Consent