• Grief Recovery Method Registration and Informed Consent Form

    Grief Recovery Method Registration and Informed Consent Form
  • Soulciety61 | Grief Recovery Method® Program

    Soulciety61 is a relational wellness organization providing coaching, educational programs, and facilitated support experiences focused on mental, emotional, spiritual, and relational well-being.

    This registration form is for participation in The Grief Recovery Method® Program, an evidence-based educational program designed to help individuals address unresolved grief related to life losses.

    Loss can take many forms, including the death of a loved one, divorce or relationship changes, health challenges, career loss, loss of trust, or other significant life transitions. The Grief Recovery Method provides a structured, step-by-step process that helps participants identify incomplete emotional communications connected to loss and take meaningful action toward healing and completion.

    The program is facilitated by certified Grief Recovery Method Specialists. While facilitators may hold graduate-level education and professional credentials in counseling, coaching, or mental/behavioral health fields, the Grief Recovery Method program itself is educational and action-oriented, not psychotherapy or clinical mental health treatment.

    Participation in this program is voluntary and designed to support emotional awareness, healing, and personal growth through guided exercises, discussion, and practical grief recovery tools.

  • Please select the service date you are signing up for.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Loss ReflectionWhich type of loss or life change is most connected to your interest in the Grief Recovery Method® Program?
  • Program Readiness: The Grief Recovery Method® Program includes reading, written reflection exercises, and guided action steps between sessions.Are you willing to complete these exercises as part of the program?
  • Handbook: We work extensively from The Grief Recovery Handbook 20th Anniversary Expanded Edition as we go through The Grief Recovery Method® Program. Do you already have a copy of this book or will you need one sent to you (it is included in the registration at no additional cost).
  • Participant's Rights and Responsibilities

    Participants in the Grief Recovery Method® Program are entitled to a respectful and supportive learning environment.

    Participants have the right to:

    Participate in the program at their own pace and share only what they feel comfortable sharing.
    Ask questions about the program process, exercises, or expectations at any time.
    Expect a safe, respectful, and confidential environment within the limits of applicable laws.
    Discontinue participation in the program at any time if they feel it is not appropriate for them.
    Participants are asked to:

    • Attend scheduled sessions consecutively and consistently as your participation affects the group and processing throughout the sessions.
    • Complete reading and written exercises assigned as part of the program process.
    • Respect the confidentiality and privacy of other participants if participating in a group format.

    While many participants experience meaningful relief and healing through the Grief Recovery Method, individual results cannot be guaranteed.

     

    Confidentiality

    Soulciety61 and its facilitators are committed to maintaining the confidentiality of participant information to the extent permitted by law.

    However, confidentiality may be limited in circumstances where disclosure is required or permitted by law, including but not limited to:

    • Suspected child, elder, or dependent abuse
    • Credible threats of harm to oneself or others
    • Legal requirements such as court orders or subpoenas

    In group programs, participants are asked to respect the privacy of others by not sharing personal stories or identifying information discussed by other participants outside of the group setting.

  • Program Fees and Payments

    Program fees for the Grief Recovery Method® Program are based on the advertised price at the time of registration.

    Current Program Price: Online 8 Week Group = $599 | Alumni Group = $295

    Payment for the program is due in full prior to the first session unless a different arrangement has been expressly approved in writing by the facilitator before the program begins. Any alternative payment arrangement is offered solely as an exception and does not constitute a pay-as-you-attend agreement. Participants remain responsible for the full program fee regardless of attendance or continued participation.

    Late Payments

    If an approved payment arrangement is not honored, participation in the program may be suspended until the account has been brought current. Any accommodation or payment extension is granted solely at the facilitator's discretion and does not waive or modify the participant's financial responsibility.

    Payment Disputes / Chargebacks

    By submitting payment, the participant certifies that they are authorized to use the payment method provided. If another person's credit or debit card is used, the participant affirms that the cardholder has authorized the transaction.

    Any chargeback or payment dispute filed on an authorized transaction does not cancel the participant's financial obligation under this agreement. The participant remains responsible for the full program fee, and participation may be suspended until the account has been brought current.

    The participant further agrees to reimburse Soulciety61 for any documented bank fees, chargeback fees, payment processing fees, or other direct financial losses incurred as the result of an invalid or mistaken payment dispute, to the extent permitted by applicable law.

    ***Program fees are non-refundable once the program has begun, unless otherwise determined by the Grief Recovery Method Specialist facilitating the program.No refunds will be issued once the first program session has begun. Withdrawal from the program, regardless of the reason, does not cancel or reduce the participant's financial responsibility for the full program fee.

  • How would you like to pay for the Grief Recovery Method® Program?
  • Zelle Payment Instructions

    Please send your program payment of $599 for 8 Week Group or $295 for Alumni Group via Zelle to:

    n2gsoulciety61@gmail.com

    Memo: GRM Program – Your Name

  • Venmo Payment Instructions

    Please complete your program payment of $599 for 8 Week Group or $295 for Alumni Group via Venmo by clicking:

    @LeAnzarStockley

    Memo: GRM Program – Your Name

  • Square Payment Link

    If paying by credit or debit card, please use the secure link below, respective to the group you are signing up for. Be advised that processing fees are include and you will be charged a total of $620 for the 8 Week GRM Foundations Group or $305.38 for the 4 Week Alumni Group

     8 Week GRM Foundations Group Payment Link via Square

     

     Alumni Group Payment Link for Square

  • PayPal Payment Link

    Please complete your payment using the respective PayPal link below. Be advised that processing fees are included and you will be charged a total of $620 for the 8 Week GRM Foundations Group or $305.38 for the 4 Week Alumni Group.

    8 Week GRM Foundations Group Payment Link via PayPal

     

    Alumni Group Payment Link via PayPal

     

  • Participant Acknowledgement and Consent

    Participant Acknowledgement and Consent
    By signing below, I acknowledge that:

    • I understand that the Grief Recovery Method® Program is an educational program designed to help individuals address unresolved grief related to loss.

    • I understand that services provided through Soulciety61 and its facilitators do not constitute psychotherapy, medical treatment, or licensed mental health services.

    • I understand that participation in this program is voluntary.

    • I understand that emotional responses may arise while discussing past losses, and I accept responsibility for my participation in the program.

    • I agree to respect the confidentiality and privacy of other participants if participating in a group setting.

    • I understand the program fee structure and payment expectations.

    By signing below, I acknowledge that I have read and understand the information above and consent to participate in the Grief Recovery Method® Program.

  • Date Signed
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: