Sophia Rising Program Application & Agreements

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WELCOME! Please fill out this application & submit your deposit, in order to be considered for our program.

After you fill out this application, we will contact you to confirm your space in the program, to set up a phone chat with Shardai, and to get you all set up for our journey together!

Thank you for your time and consideration. We look forward to receiving you. :D

Email *

Full Name *

Are you a new or existing client? *

I am a new customer

I am an existing customer

I have taken classes, but am new to private session work

What is it in particular that draws you to this program? *

What are your core practices for self-regulation and self-awareness? *

How did you find out about our program? *

I am a previous client or student

Referral (list person under 'other' if applicable)

Facebook group

PMT community

Priestess Presence community

Google/Web search

Other:

Required

Are you under any psychiatric care at this time, or have you been in the past? If so, where are you at with that process now? (please answer honestly, so we can assist you best) *

Though deeply transformative, I understand that this is not a licensed therapy program, and is not a replacement for professional mental health or counseling services. *

YES, I understand and agree

NO, I do not understand nor agree

I understand this program requires my presence to attend a final in-person retreat in Hawaii, and I am able to commit to this, and associated extra costs of travel. If I cannot attend due to emergency/illness only, my retreat costs will be refunded less a $500 surcharge. Otherwise nonrefundable. *

YES, I understand and agree

NO, I do not understand nor agree

Do you agree with our program terms? Check all boxes below to agree. *

I understand my deposit is non-refundable.

Once begun, I am responsible for the completion of any agreed upon payment plan costs in full, whether or not I complete the program. Any payments done in full are nonrefundable.

I agree to communicate with Shardai if I have major issues with the program, and understand they will be addressed and remedied if possible, by dialogue with both parties.

I take responsibility for my own involvement in this program, and agree to not hold Sophia Rising LLC or Shardai Moon responsible for any unintended adverse emotional, physical, or mental consequences associated with my program.

I understand that any non-emergency rescheduling of 1:1 sessions needs to happen within 24 hours of the session, less a $25 rescheduling fee will be charged to my card on file.

Required

Anything else Shardai should know?

Submit

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