Altered Book Art Journal Event Registration Form

Altered Book Art Journal Event Registration Form

Please fill out the following information to finalize your event registration
Participant Name*

First NameLast Name
Preferred Pronouns
Participant Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about us?*
Any accessibility needs or accommodations required? *
While we can't always guarantee we will be able to comply with all requests we will do our best to accommodate as we are able to.
Is there anything you would like your facilitators to know to support your experience?*
Have you attended similar events before?*
Are you currently experiencing anything that would make group participation difficult?*
Informed Consent

Please review each section checking each box to demonstrate acknowledgement of each statement as well as e-sign below to show your understanding and acceptance of expectations and consent to participate in this event/workshop.
Photo/Video Consent: Wildflower may take photos or short videos during this event for future promotional use. We strive to do so respectfully and never wish to compromise anyone’s comfort or privacy.*

I consent to being photographed/video recorded and for images to be used by Wildflower for promotional purposes.I consent to group/wide-angle photos only (not close-up identifiable images).I do not consent to being photographed/video recorded.
Nature of Event: I understand this event is educational / wellness focused / creative in nature and is not considered psychotherapy or a substitute for mental health therapy.*

I agree with and understand the above statement
Voluntary Participation: I understand participation is voluntary, and I may step out or discontinue participation at any time.*

I agree with and understand the above statement
Emotional Activation Disclaimer: I understand reflective and creative activities may bring up emotions, and I am responsible for monitoring my own wellbeing and seeking support if needed.*

I agree with and understand the above statement
Group Confidentiality (if group sharing takes place): I agree to respect the privacy of others and keep personal sharing confidential, recognizing absolute confidentiality cannot be guaranteed in community settings.*

I agree with and understand the above statement
Physical Participation (if movement/activity is involved): I understand I am responsible for participating within my own limits. I understand I should modify or stop any activity that feels unsafe or uncomfortable.*

I agree with and understand the above statement
Refund/Cancellation Policy: Due to limited space and advance preparation, cancellations made 7 or more days before the event are eligible for a refund (minus payment processing fees) or full credit toward a future event. Cancellations within 7 days are non-refundable, though you may transfer your spot to another person with advance notice. If Wildflower must cancel or reschedule, a full refund or transfer option will be provided.*

I agree with and understand the above statement
I understand that participation in this event may involve ordinary risks associated with attending a community gathering, including movement within the space, use of materials, emotional discomfort, or accidental injury. I agree to participate voluntarily, use my own judgment, and take responsibility for participating within my personal limits.*

I agree with and understand the above statement
Agreement

By e-signing below you are demonstrating you have read, understood and agree to the above consent and expectations statements regarding this event.
Signature*
Complete Registration Payment*
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Altered Book Art Journal Event
Learn how to start and use your own altered book art journal as a creative practice.

$35.00 Quantity
Item subtotal:$0.00

Hardcover Book
You are welcome to bring your own hardcover book or purchase one from us. You will be able to pick out your book at the beginning of the workshop.

$5.00 Quantity
Item subtotal:$0.00

Total

$0.00
Please let us know if you have any additional questions or concerns regarding this event/workshop:
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Altered Book Art Journal Event Registration Form

Informed Consent

Agreement