Immersion into Self application form

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

Event Timing: 8 consecutive weeks starting Sunday 19th Feb 2023 Melbourne, Australia time
ONLINE

Email *

Name *

Address *

Phone number *

What other types of personal development work have you done? *

I understand this is not therapy *

I am not currently in therapy

I have never been in therapy

I was in therapy and I am currently stable and not requiring therapy

I am currently in therapy and I have consulted with my therapist on attending this training

I am currently in therapy and I have not consulted with my therapist about attending this training

Do you have any mental health conditions? e.g. Depression, Anxiety, Panic Attack, suicidal thoughts in the past, any other. *

I accept full responsibility for my participation. *

I accept full responsibility for my participation and processing throughout this workshop as it often involves intense emotional experiences.

Required

If I suffer any significant physical or psychiatric condition to notify the organiser prior to booking, or least 24 hours before the workshop/session (whichever is the earlier). *

I agree. If I suffer any significant physical or psychiatric condition to notify the organiser prior to booking, or least 24 hours before the workshop/session (whichever is the earlier).

Do you have a support network around you e.g. Family/Partner/Friends/Colleague/other? *

Yes

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms