Wellness Classes

Class Registration and Consent Form

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1. First and Last Name (Required.)

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2. Phone Number (Required.)

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3. Email Address (Required.)

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4. Course/s you are registering for (Required.)

The Mental Wellness Challenge - Part 1

The Mental Wellness Challenge - Part 2

The Relationship Wellness Challenge

The Spiritual Wellness Challenge

The Physical Wellness Challenge

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5. How did you hear about these courses? (Required.)

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6. I personally give Dr. Elaine Stevens permission to consult with me concerning these courses. I understand that Dr. Elaine Stevens is not responsible for any adverse behavior or choices I make as a result of these courses. (Required.)

Agree

Disagree

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7. Each class lasts for 10 days and cost $10. I agree to pay all charges in full before the class begins. (Required.)

Agree

Disagree

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8. I understand that these challenges are for my eyes only and are intellectual property of Matters of The Heart, LLC. I will not forward the challenges to anyone without permission. If I want others to participate, I will pass the website on to them so that they can personally sign up. Also, I will not disclose any information to anyone outside of the group that is shared on Zoom Calls. (Required.)

Agree

Disagree

Wellness Classes

Class Registration and Consent Form

Question Title

* 1. First and Last Name (Required.)

Question Title

* 2. Phone Number (Required.)

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* 3. Email A﻿ddress (Required.)

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* 4. Course/s you are registering for (Required.)

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* 5. How did you hear about these courses? (Required.)

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* 6. I personally give Dr. Elaine Stevens permission to consult with me concerning these courses. I understand that Dr. Elaine Stevens is not responsible for any adverse behavior or choices I make as a result of these courses. (Required.)

Question Title

* 7. Each class lasts for 10 days and cost $10. I agree to pay all charges in full before the class begins. (Required.)

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* 9. Signature (Required.)

1. First and Last Name (Required.)

2. Phone Number (Required.)

3. Email Address (Required.)

4. Course/s you are registering for (Required.)

5. How did you hear about these courses? (Required.)

6. I personally give Dr. Elaine Stevens permission to consult with me concerning these courses. I understand that Dr. Elaine Stevens is not responsible for any adverse behavior or choices I make as a result of these courses. (Required.)

7. Each class lasts for 10 days and cost $10. I agree to pay all charges in full before the class begins. (Required.)

9. Signature (Required.)