Name *

First Name

Last Name

Phone

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Date of Birth: *

MM

DD

YYYY

Are you on any medication? *

Yes

No

Phone *

(###)

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Photography and Media Release: *

I hereby grant permission for my likeness to be used in event photographs or videos, which may be utilised for event memories and promotional purposes. If I choose not to, I will inform the organisers in writing prior to the event.

Yes, I grant permission.

No, I do not grant permission.

Disclaimer *

Before we embark on this journey together, we'd like to address a few key aspects that are important for a successful and enriching experience: The event can involve emotional experiences. Participants voluntarily engage in the workshop and are responsible for their well-being and decisions. Please be aware the workshop is intended for life coaching purposes. While the facilitators provide guidance and support, they are not providing medical, therapeutic, or professional advice. It is your responsibility to disclose any physical or mental health issues you have so we can guide you appropriately. We'll use your personal information only for event communication and administration purposes.

I agree

Agreement *

By signing below, you confirm your agreement with these terms and embark on this enriching journey with us.

First Name

Last Name