Embodied Evolution enrolment
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Email *
Name *
Date of Birth
Where did you hear about Embodied Evolution? *
What do you hope to gain from the process, by September 2022? What inspires or excites you about embarking on this group programme, at this time in your life?   *
What kind of inner work / personal development have you engaged in previously? Please briefly share anything you feel is relevant here. *
What helps you stay connected to yourself, in daily life? What practices or resources (inner / outer) can support or enhance your engagement in this programme? *
What part of the world are you from / living in? Anything else about yourself that you'd like to share with me here?
I confirm I have read the ‘What to Expect’ section on the programme page at: https://embodymytruth.com/embodiedevolution , and I am happy to proceed on this basis *
Required
I agree that the group and private sessions should not be used as a substitute for counselling, psychotherapy, mental healthcare or substance abuse treatment, and will not use it in place of any form of diagnosis, treatment or therapy. I agree to take responsibility for seeking appropriate care, should the need arise *
Required
I agree that the group and private sessions should not be used as a substitute for counselling, psychotherapy, mental healthcare or substance abuse treatment, and will not use it in place of any form of diagnosis, treatment or therapy. I agree to take responsibility for seeking appropriate care, should the need arise *
Required
I understand that Delphine may recommend seeking an alternative service more suited to my current needs, should this become apparent. In this event, reasons for recommendation will be fully discussed, and it is my sole responsibility to decide whether to follow it, with no liability on Delphine’s part for the outcome of any decisions I choose to make. *
Required
I understand that weekly group sessions via Zoom will be recorded, hosted on a private membership platform, accessible by all group members, and may also be shared via email / private Facebook group. I agree to being recorded. (If a group member asks for the recording to be paused on occasion, should a particularly sensitive topics / experience arise, we can arrange this). *
Required
I agree that all personal information shared by participants will remain strictly confidential, except where specifically required by law, e.g.:    If there is a serious risk of harm to a person; in case of court proceedings and subpoena to give evidence; if any criminal activity or knowledge of such is disclosed; if information is shared regarding a child who has or is being emotionally, physically or sexually abused, or is at risk of abuse, requiring mandatory reporting.
I anticipate being able to show up live on Thursdays for weekly group sessions, all / most of the time (or at minimum half the month's sessions) *
Any questions for me? You can also contact me at delphine@embodymytruth.com
Please select how you would like to pay, and I will send you an invoice and payment link
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Many thanks for completing the form. I will be in touch soon!

Warm wishes,

Delphine
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