Sound Bath & Meditation Registration
Register for the monthly meditation session at Life Enhanced Counseling Services, designed for moms raising children on the autism spectrum. All fields are required.
Participant Full Name
*
First Name
Last Name
Participant Email Address
*
example@example.com
Participant Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Please Select
Phone
Email
Text
Other
Are you a mom raising a child on the autism spectrum?
*
Please Select
Yes
No
Case Manager Name
*
Case Manager Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Case Manager Email
*
example@example.com
Please Select ALL Sessions You Plan To Attend.
*
Thursday August 20, 2026 6PM-7:30PM
Thursday September 17, 2026 6PM-7:30PM
Thursday October 15, 2026 6PM-7:30PM
Thursday November 19, 2026 6PM-7:30PM
Thursday December 17, 2026 6PM-7:30PM
Thursday January 14, 2027 6PM-7:30PM
Do you have any accessibility needs or accommodations?
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I understand and consent to Life Enhanced Counseling Services contacting my CLTS Case Manager to authorize payment for this service.
*
Yes, I agree and provide consent.
Consent to be contacted by Life Enhanced Counseling Services regarding this and future meditation sessions.
*
I consent to be contacted by Life Enhanced Counseling Services regarding this and future meditation sessions.
Register
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