Workshop Registration & Agreement

Thank you for your interest in joining one of our healing workshops. Please take a few moments to complete this form so we can better support you and create a safe, supportive experience for everyone involved.

Personal Information

Full Name

Preferred Name (if different)

Email Address

Phone Number

Age

City & State

Emergency Contact Name & Phone Number

Workshop Selection

Which workshop are you registering for?

Whole Again — Signature 10-Week Program Returning to Calm — Nervous System Regulation Learning to Choose Yourself — Codependency & Self-Abandonment Returning Home to Yourself — Childhood Trauma Healing Finding Your Own Path — Teens of Emotionally Unavailable Parents High Conflict Divorce Holding On to Hope

Workshop Questions

What drew you to this workshop at this time in your life?

What are you hoping to gain or experience through this workshop?

Have you previously participated in therapy, coaching, support groups, or healing work?

Yes No Prefer not to say

If comfortable sharing, please briefly explain:

Are there any topics, triggers, sensitivities, or emotional concerns you would like us to be mindful of?

How would you currently describe your emotional wellbeing?

What helps you feel emotionally safe and supported?

Is there anything else you would like us to know before the workshop begins?

Workshop Agreement & Participant Guidelines

Our workshops are designed to provide educational support, emotional reflection, nervous system awareness, and community connection in a compassionate and respectful environment. By participating, you acknowledge and agree to the following:

Educational & Coaching-Based Support. Whole Again workshops are educational and coaching-based experiences and are not a substitute for therapy, psychological treatment, medical care, crisis intervention, or legal advice.
Personal Responsibility. Participants are responsible for their own emotional wellbeing, choices, and participation throughout the workshop experience.
Emotional Safety. Healing conversations may bring up emotional discomfort, grief, memories, or strong emotions. Participants are encouraged to care for themselves gently and participate at a pace that feels emotionally safe.
Confidentiality. Participants agree to respect the privacy and confidentiality of others in the group. Personal stories, experiences, or identifying information shared within the workshop should not be discussed outside the group setting.
Respectful Participation. Participants agree to contribute respectfully and compassionately toward others. Harmful, abusive, discriminatory, or disruptive behavior will not be tolerated.
Attendance & Participation. While participation is encouraged, participants may choose their level of engagement and are welcome to step away briefly if emotionally needed.
Crisis Support. Whole Again workshops are not crisis services. If you are experiencing thoughts of self-harm, suicidal ideation, domestic violence danger, or immediate emotional crisis, please contact emergency services, a licensed mental health professional, or a crisis support hotline in your area.
Technology & Virtual Sessions. Participants are responsible for ensuring they have access to a stable internet connection and private environment for virtual sessions whenever possible.

Participant Consent — please check each statement below:

I understand this workshop is educational/coaching-based and not therapy.

I understand participation may bring up emotional responses.

I agree to maintain confidentiality and respect within the group.

I understand I am responsible for my own wellbeing and participation.

I understand Whole Again is not a crisis service.

Participant Name

Date

Welcome to Whole Again

Workshop Registration & Agreement

Personal Information

Workshop Selection

Workshop Questions

Workshop Agreement & Participant Guidelines