Enroll in classes - RoseLight

Date mm/dd/year*

I would like to reserve my place in (specify Class or Consultation):*

Name:*

First

Last

Address:*

Street Address City State / Province / Region Postal / Zip Code Country

E-mail:*

Phone:*

Area Code

–

Phone Number

I would like assistance with:*

What I would like to release*

What I would like to create*

Any other information I would like to share*

RoseLight’s spiritual direction work in classes and consultations 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 participation 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 RoseLight work is a form of life/stress management and pastoral care and 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.

Informed Consent*

Accept

Don’t accept

Your initials to confirm consent*

Recaptcha Word Verification:

Send a copy of this message to yourself*