Heal Your Life Workshop Registration Form

Thank you for your interest in the Heal Your Life Workshop!

Please share some info about yourself for upcoming heal your life workshop on:

  • Date: To be announced 
  • Time: 7:30 to 8:30 PM IST/ 9:00 to 10:00 AM EST, Every Sunday for 10 weeks. 
  • Location: Online 

Investment: 

  •  Rs-5000, for Indian Citizens 


Payment Options:

  • G-PAY: 8940110490129@paytm

Facilitator

Poornima Murugesan
International Licensed Heal Your Life®️ Teacher 

 Registered Bach Flower Practitioner 

For other details, please email- thesoulline@myyahoo.com

Refund Policy 

Refunds will not be provided if you cancel your course registration two week (14 days) or less before the scheduled course start date

Name *
Please enter your full name
Age *
Please select the age range applicable for you
Gender *
Pronouns *
Occupation *
Please share your general line of work
Phone Number (WhatsApp with country code)
*
Email *
Address *
City/ Country *
Do you need any special assistance to participate in this workshop? *
If assistance is required, we will work with you to make sure your needs are addressed before the commencement of the workshop
How did you hear about the workshop?
*
必填
Any health related conditions or diseases?
*
必填

Indemnification Agreement :

By submitting this form, I acknowledge that 100% attendance in the Heal Your Life 2-Day Workshop is recommended. I understand that the organizers, instructors, and venue are not liable for any injury, loss, or damage to personal property during the workshop. I also understand and acknowledge that the workshop facilitators and assistants are not psychologists, psychotherapists, or medical doctors of any kind, and the workshop is designed for personal development purposes only.

 

I, the undersigned, affirm that I am over 18 years old and understand that participation in this program is not a substitute for medical attention, physical, psychological, examination, diagnosis, or treatment. I agree to take full responsibility for my health during participation in these classes and programs. Furthermore, I recognize that it is my responsibility to notify the facilitators of any serious illness or injury and to ask for clarification on anything that I do not understand.

 

I acknowledge and agree that my attendance and participation in the workshop are necessary. Since participating could involve physical activity, I agree to assume the risks associated with attending and participating in the workshop to the fullest extent permitted under applicable law.

 

To the extent permissible by law, I agree to indemnify The Soul Line against any and all claims, actions, losses, and damages arising out of or relating to my participation in the workshop. I waive claims against The Soul Line (including its subsidiaries, affiliates, officers, volunteers, agents, partners, teachers, trustees, founder, and employees) for any injuries I may sustain because I participate in the workshop and assume full responsibility for all my actions. Any medical/legal expenses incurred in this regard will be fully borne by me.

*

MEDIA RELEASE CONSENT:

All participants in this workshop must understand and acknowledge that the workshop may be recorded for educational and promotional purposes. I consent to the recording and use of my image and/or voice during the workshop.

 I agree that I will not be taking any photos or videos of the ongoing workshop or any participants.

*

Consent to Include Phone Number to the workshop Whatsapp group

*
Signature *
Please enter your full name and date as a signature for this form
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