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Wellness Classes
Class Registration and Consent Form
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1.
First and Last Name
(Required.)
*
2.
Phone Number
(Required.)
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3.
Email A
ddress
(Required.)
*
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.)
*
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
*
9.
Signature
(Required.)
Current Progress,
0 of 9 answered