Virtual Workshop Registration Form

14 Week Virtual Workshop Registration Form
Participant Information
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearNote - You Must be 18 or older to Register
By signing below, I am acknowledging the nature of this course. I understand this course is not therapy or treatment, I am therefore not considered a client, and the facilitators of this course are not considered my therapists. I am attending to learn information associated with tools and skills to assist me in meeting my own personal life goals. If I recognize that I need additional help, beyond the scope of this course, I understand it is solely my responsibility to seek a referral to a licensed mental health professional or other appropriate treatment.
Signature
Once you submit your form, you will receive an email with a link to important details about your training.

Note: If you are registering after November 10, 2026 you will automatically be placed on a list for the next 14 week course.
Should be Empty:

Participant Information