Class Registration Form

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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How did you hear about my class(es)* This field is required.
Facebook
Instagram
From the Roots Holistic
Friend/Family Member
Nickel Refillery
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How will you be paying for your class registration?* This field is required.
Credit card
E-transfer
Nickel Refillery, Staff Training
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Which class are you registering for?
Essential Oils 101, Virtual Class $15.00
Nickel Refillery, Staff Training
Breastfeeding I: Establishing Breastfeeding $50.
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Which class are you registering for?
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$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costCAD
Essential Oils 101, Virtual ClassPlease enter a short description.
$15.00CAD+Remove
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Breastfeeding I: Establishing Breastfeeding
$50.00CAD+Remove
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Total cost $0.00CAD
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
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When would you like access to the virtual class?For administration purposes, please do not request access to the virtual class within the next 48 hours.
Date
Year
Month
Day
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Terms/Disclaimer
Information provided during the program does not take into account all individual conditions and may therefore not be advisable or beneficial to all participants.
Dana Clark/From the Roots Holistic is not liable for misuse, misunderstanding, injury or health issues that may ensue from the information provided during the program.
Information provided by Dana is in accordance with her formal academic training, continued education, and science-based research.
Refund Policy: Sorry no refunds, all sales are final.
Virtual classes require a youtube account to access, you will receive an email with a link to the class and handouts. You will have access to the class for 48 hrs.
Webinars are held via Google Meet, be sure to check your emails 10 minutes prior to the class for a link to the session.
Scheduled classes are held at various venues with different setups and requirements, for this reason, I have a registration deadline of 48 hours prior to scheduled classes and do not allow for walk-ins or those who have not confirmed their spot with full payment. This policy also assures that enough handouts/materials are also available.
Warning: Individuals who are sensitive to smells, have environmental/seasonal allergies, or those with underlying health conditions may be at risk of experience a reaction during in-person Essential Oils classes. It is at the participant's discretion on whether they would like to book/register and take any possible risk. From the Roots Holistic/Dana Clark is not liable for any injury/reaction/or illness that may occur.

I have read and agree to the terms/disclaimers listed above.
Signature * Date *
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