One-on-One Online Mentorship with Juliet Haines

Private Online Mentorship

With Juliet Haines
APPLICATION FORM

Greetings,

Thank you for your request to join the "One-On-One Mentorship" with Juliet Haines.

Please complete the form below. After your form is completed, please visit Juliet's schedule to schedule your session and to make payment.

Here is the link to the schedule - https://go.oncehub.com/JulietHainesClients

The Mentorship consists of a suggested 3, 6 or 9 Month Program online via zoom for deep transformation and awakening inner union.

Meetings are weekly alternating individual and couples sessions. Individual sessions are $180 and couples sessions are $250 per session.

With care,
Lara
Program Coordinator
Application:

Thank you for taking the time to complete this form.
Full Name *

First Name Last Name
E-mail *
Date of Birth:
What is calling you to apply for this mentorship program? *
What are your intentions in joining this mentorship program? *
Have you attended previous courses, sessions or retreats with Juliet? *

YES NO
If Yes, please describe in what way you participated and your experience:
What other programs have you attended for awakening the feminine/masculine or personal transformation? *
Do you have a regular spiritual practice (meditation, prayer, yoga) and if yes please describe? *
Do you have any medical conditions that we should know about or are you under the care of a mental health practitioner and please describe? *
Do you have any history of sexual trauma or abusive relationship that you would like Juliet to know about? *
Is there anything else you feel you would like to share or we should know about? *
Where did you hear about this mentorship program? *
By signing below you agree to the Juliet Haines Agreements and Policies:
- I understand I shall receive from this experience what I put in and take responsibility for myself.
- I am deeply committed to my self-care and I am self-resourced with the ability to find supplementary outside support for my healing process if this is needed.
- I am responsible for asking for what I need and for my own awakening and transformational journey.
- I respect the intimacy of this container and I will not publicly share what is discussed.
- I am committed to following through on the financial investment.
- I understand that there are no refunds for registering for this PROGRAM.
- I agree to the Juliet Haines Agreements and Policies.
Signature *

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Private Online Mentorship

Application: