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Daring way™ Group Registration

Part two - continuation for February Group participants

March 28 - May 9, 2018

Name *
Name
Fee Schedule *
Group fees are non-refundable. Weekly fees are billed regardless of attendance.
Payment Method *
Credit cards will not be billed until group participation threshold is met (ie. 5 or more registrant).
Participation Agreement: I agree to take care of myself while I participate in this group. I understand that group participation is not the same as nor intended to replace individaul therapy and will seek additional support should the need arise while I participate in this group. I understand my participation in this group is voluntary and I have the right to withdraw at any time, though I will not recieve a refund for partical participation and will make an effort to attend all sessions. As I have already participated in Part 1 of this group, my previously signed consent forms on file still apply. *
Date *
Date