RJIOK UU Foundation Course 2022

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Application for participation.

Email *

Name *

Phone *

Preferred pronouns (she, they, he, etc) *

In which industry do you currently work? *

Unemployed/Retired

Education

Government

Healthcare

Fire/EMS/Law enforcement or other first responder

Military

Nonprofit

Student

Religious

Other:

Emergency Contact *

I am 18 years old or older *

Yes

Required

In 2-3 sentences please tell us about yourself. *

In 2-3 sentences please tell us why you are interested in the Foundations course *

We will be teaching stress-related techniques and it is helpful to know your current stressors: Please check if you are experiencing any of the following: *

Trauma

Grief

Feelings of Anxiety

Feeling Depressed or overwhelmed

Difficulty Focusing

Trouble Sleeping

Laid off or reduced hours due to Covid

Supporting children at home in school due to Covid

Other:

Required

Other than teaching, do you have previous experience facilitating Adult groups? If so please elaborate. *

By submitting this registration form, I am seeking to participate in the UU/RJIOK Foundation Course. I understand that each group has a maximum of 24 participants. In addition to theory, I will be taught self-awareness and mind-body techniques (such as meditation, guided imagery, biofeedback, working with drawings, breathing, IFS, and movement). The group combines didactic learning, experiential learning, practice and group support. This experience is grounded in self-reflection modalities that may bring up strong, transformative emotions within oneself as well as being witness to other’s emotions and experiences within the online group. We find that sharing and connecting with others creates a wonderful learning environment, helping you become more self-aware and engaged in self-care. Regular opportunities for sharing are offered in support of building both self-expression and connection with others. Sharing is encouraged yet unforced. *

Yes, I'm able to make a commitment of punctual attendance to 12 Afternoons and 2 Saturdays.

Yes, I understand the course requires a willingness to engage in group sharing.

Yes, I understand the course requires a willingness to engage in experiential learning.

Yes, I understand the course will be conducted over Zoom.

Yes, I understand I am to have a brief interview with a facilitator before the first session to test the technology and be certain that this course is for me at this time.

Yes, I understand that I will be asked to participate in an evaluation process at the end of the group.

Yes, I understand that there will be homework between sessions that is required to fully experience the materials.

Required

Course Fee- $1200 We keep the course fees low to make it accessible You may also apply for additional funding through your church or your current employer. We want to ensure that anyone who wants to participate in one of our Foundations Courses is able to do so. Those who can afford to contribute additional funds are essential to us continuing to bring our circles to all who need them. You can set also up a payment plan with the facilitator at your interview. How much are you willing to pay for your 48 hours of contact learning and ongoing support throughout? *

PLEASE READ THIS SECTION CAREFULLY & COMPLETELY, AND CHECK THE BOX BELOW TO AGREE TO THESE TERMS AND CONDITIONS OF PARTICIPATION INCLUDING LIABILITY RELEASE. I understand that this course is an educational, supportive group built upon developing self-awareness skills and are not formal mental health therapy. I understand that the techniques recommended are not intended to be a substitute for conventional medical treatment or to replace the medical decisions of my healthcare provider(s), whom I will consult prior to applying to participate if I am currently engaged in psychotherapy. All matters concerning my health are the responsibility of myself and my health care provider(s). In an effort to facilitate a positive experience for online group members, our course is intended to provide a safe place for all. RJIOK reserves the right to remove from attendance and from enrollment at any current or upcoming online group or activity, anyone whose actions, in RJIOK's discretion and judgment, are disruptive, violate the group guidelines, or otherwise interfere with the program. In such circumstances, RJIOK retains the discretion to grant or withhold refunds of registration fees, in full or in part. LIABILITY RELEASE In consideration of the services provided by RJIOK, I do hereby assume all responsibility for and all risk of, including but not limited to, damage or injury that may occur as a result of my own actions, inactions, or negligence, or that of others as a client of RJIOK. I further understand that I am releasing and discharging any and all claims and causes of action of any kind or nature that are directed toward RJIOK, including but not limited to, its officers, agents, and employees. This includes, but is not limited to: causes which are known or unknown, specifically mentioned or implied, or not mentioned nor implied, which might exist or be claimed to exist at or prior to the date of completion of this registration. The registrant further specifically waives any claim or right to assert that any cause of action or alleged cause of action or claim or demand has been, through oversight or error, intentionally or unintentionally omitted from this release. The terms herein shall serve as a release, indemnification, and assumption of risk for my heirs, executors, and administrators, and for all members of my family. Signing the box below is the equivalent of an electronic signature and indicates acceptance of all of the above Terms and Conditions of Participation including Liability Release. *

Yes, I agree to these conditions and the liability release.

Required

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