Group Coaching Registration
Registration, Disclosure, and Agreements
September 23, 2010 – November 11, 2010
Please copy, fill out, and email this form to jennyrock@me.com. Upon completion of your registration, we will get the phone bridge and entry code numbers to you.
Name:
Address:
City/State/Zip:
Phone:
*Email:
- Have you taken the Course offered through The Field Center (classroom or home study)? If so, when? What was your experience?
- Other than the last question above, do you have any previous experience with Field Training or The Field Center? If yes, please specify.
- What brought you to this group at this time in your life?
- Do you have experience with traditional counseling? If so, please explain what you thought of the process and results.
- Please list any questions you feel we should address prior to the Class.
Group Coaching Tuition: $125.00 (Select 5 units of $25.00)
Group Facilitating Tuition: $175.00 (Select 7 units of $25.00)
For a prearranged payment plan, select the appropriate number of units:
Once on the PayPal website, click “continue shopping” to return here.
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- I am aware that this class is educational, not therapeutic, and does not make any therapeutic claims.
- I am committed to bringing my willingness to each class.
- I am committed to keeping all shared personal information completely confidential, including recording devices, which may not ever be used by anyone at any time.
Jenny Rock is a Certified Field Center Facilitator and a Field Center Certified Coach working independently of The Field Center. Cathey Polly is a Field Center Certified Facilitator and Coach working independently of the Field Center.
*We will never sell, give, or distribute in any fashion ANY personal information to any third party, including email, physical address, or telephone number.
