Family Constellations Facilitator Training Certification Program Application

Family Constellations Facilitator Training Certification Program Application
Full Name
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Address Information

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Where were you born?
What is your current life situation?
Current Occupation
Past occupations or experiences
Personal WorkOnline WorkshopsIn-person WorkshopsRepresentedTrainingFacilitatorBooksVideoIn-Person Conference or IntensiveOnline Conference or Intensive
Type your own response
What year did you first encounter Family Constellations?
Why do you want to become a certified facilitator?
What other professional trainings have you participated in?
High SchoolCollegeGraduate SchoolDoctorate
AcupunctureBodyworkBreathworkChinese MedicineChiropracticEnergy WorkMeditationNLPPlant MedicinePsychotherapyShamanismSweat LodgeTai ChiYoga
FriendFamilyInternetFacebookProfessional RecommenationSomeone in the program

What else would you like to share about yourself?
Agreement
I have read the training certification requirements and I understand what must be completed to become certified. I understand the costs involved. I agree to the Code of Ethics.

I agree to the "Groups, Workshops, Training Policies + Participation Agreement." I also agree to the Representative Guidelines.
Recipient initial
Notes, documents, videos or recordings from any part of this certification will ONLY be used for my personal use and not shared with anyone.
Recipient initial
A commitment toward attaining or providing this certificate does not represent a legal agreement. Either party can withdraw from this commitment at any time without consequence. Both parties agree to do their best to honor the commitment as long as it feels true and appropriate.

By signing this document below, I willingly agree to hold harmless, and release from all liability the facilitator of this work, Barry Krost, and Healing Body Therapeutics PLLC. I consent to participate in this Family Constellations professional training.
This contract may be signed electronically or in hard copy. If signed in hard copy, it must be returned to the Business for valid record. Electronic signatures count as original for all purposes. By typing their names as signatures below, both parties agree to the terms and provisions of this agreement.
Recipient initial
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