Confidential Workshop Registration Form

So that I can best serve you and ensure you get the most out of your experience during our time together, please fill out all questions on the registration form to the best of your knowledge. I so look forward to sharing your journey.

Much love, Emma Beth

 
Personal Info
Name *
Name
Where do you live? *
Where do you live?
Workshop Detail
Please indicate your level of familiarity with the chakra system. *
What is your level of experience with sexual healing work (workshops, trainings, and/or private sessions)? *
Disclaimer
By submitting this form, I agree to attend the workshop as a participant rather than a healer/helper/giver. I understand that the workshop I will be participating in is provided for the purpose of healing, releasing, awakening, and reclaiming wholeness. I further understand that the workshop should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that the facilitators are not qualified to diagnose, prescribe, or treat any physical or mental illness and that nothing said in the course of the workshop should be construed as such. I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the facilitators updated as to any changes in my profile and understand that there shall be no liability on the part of the facilitators for any reason whatsoever.