Registration for Mothers Way

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

Welcome! I'm so glad you're here. Let me get to know you a little more through the following questions. I'll be in touch to confirm your registration.

Your name

Phone

Where are you currently living on this earth?

In one or two sentences, kindly answer the following questions.

What's drawing you to this program?

How old is your child/children? (Feel free to also share how you're doing at this stage of the whole motherhood thing.)

Okay, so I'm a therapist in Florida, and not acting as a therapist in the Mothers Way. I'll be more like a coach / guide / fellow mom. For legal and ethical purposes, are you clear that enrolling in this program does NOT constitute a therapist-client relationship?

Yes, and I'm good with this.

Other:

Clear selection

How did you find out about the Mother's Way?

Which day and time could you make? Please check both if both work for you (though there will only be one gathering each week).

Sundays, May 5th - June 9th, 1pm-2:30pm Pacific / 4pm-5:30pm Eastern

Wednesdays, May 8th - June 12th, 11am-12:30pm Pacific / 2pm-3:30pm Eastern

Legal Schtuff

Please read the terms of my Coaching Agreement, and then let me know you're cool with them.
https://www.shamelessheart.com/coaching-agreement

Coaching Agreement

I've read it and am on board!

Payment

Please make payment using this link www.paypal.me/shamelessheart. Note, if I end up offering the program on a day you cannot make it, your payment will be refunded in full.

Are you able to pay the full $217 for the program?

Yes, I can do it now.

Yes, but I need installments.

No, I am requesting a discount.

Clear selection

If you need installments or a discount, what arrangement would make this program truly doable for you while also aiming to honor my time and the contribution of this program to your life?

If you are paying in full, please send payment now via www.paypal.me/shamelessheart

If you are requesting a discount or installment plan, please wait to pay until I reach out to you via email. <3

Woo hoo, I've paid!

I'm requesting a discount or installment plan, and will wait to hear from you.

Clear selection

Anything else you'd like me to know?

Thank you so much for your time and care in responding. I look forward to being in touch!

Submit

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