Connecting Within Application Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form if you are interested in taking our Connecting Within program. Connecting Within was created to bring together the benefits of 1:1 Trauma Recovery Coaching and recreation & leisure. Through working with both April and Katie, we will help you explore blockages, explore what interests you, and find new activities to incorporate into your healing journey that you will enjoy. All sessions are 50 minutes long.

Cost for program is $765 (tax included) CAD. What you receive is: 4 (1:1) sessions with April, 4 (1:1) sessions with Katie, email support for 8 weeks, and 2 custom resources for your toolkit (1 from April and 1 from Katie).

First and Last Name *

Email *

Are you able to commit to this program for the 8 weeks? *

Yes

Are you able to commit to 1 hour sessions for the program? *

Yes

Are you able to pay the full fee up front or require a payment plan? *

Can pay full fee

Require a payment plan of 2 payments

What are your goals/hoping to get out of this program? *

Do you have any questions?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Blossoming from Within. Report Abuse

Forms