Consultation Registration Form photo of lit window of old wood tank house on the farm with potato vines growing in front

Consultation Registration Form

Consultation Registration Form

Date mm/dd/year*
Name:*
Address:*
E-mail:*
Phone:*
-
What I would like to release*
What I would like to create *
Any other information about my focus for our Consultation*

RoseLight’s work in a Consultation involves our attaining meditative states of higher consciousness. The techniques we use include guided visualizations, energy awareness techniques, subtle energy bodies, and verbal releasing and sharing. Some of the self-examination, states of consciousness, and personal insights in this work can be very stimulating, exciting, or create emotional releases. If you have a mental, physical, or emotional condition that would make a Consultation unwise in the light of this knowledge, we advise you to reconsider participation.

I understand that I am free to ask any questions about or discuss these provisions at any time. I understand that these sessions are a form of life/stress management and pastoral care and are not a substitute for medical or psychotherapeutic care. I am at least 21 years of age, or, I provide with this booking form a written and signed letter from my parent or guardian giving RoseLight permission to work with me.

I understand that the $175 tuition fee is nonrefundable once the session has taken place.

Informed consent for Consultation*
Your initials to confirm consent*
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