1.What is your first and last name?

2.What month/ year are you attending the Intensive?

3.How did you hear about this training? (For example, facebook, newsletter, a class with Lisa, conference, colleague, etc...)

4.What is the highest level of post-secondary education you have completed and from where? Please describe your degree. 

5.How many years of experience do you have in the counseling field and specifically how many years of experience do you have in the play therapy field?

6.Have you studied Synergetic Play Therapy® before? If so, what class and where? What other play therapy modalities have you studied?

7.I understand that all of the information in this training is copyrighted and trademarked and I agree to not teach the content of this Intensive without permission from Lisa Dion and the Synergetic Play Therapy Institute.

Yes

No

8.I understand that if I complete the 6-day Intensive Training or Online Introduction to Synergetic Play Therapy® training I can say that I have received “training in Synergetic Play Therapy®.”

Yes

No

9.I understand that I cannot market myself as “Certified Synergetic Play Therapist” or a “Trained Synergetic Play Therapist.” The Certified Synergetic Play Therapy® title is only for those that have completed their certificate requirements and been certified.

I understand

I do not understand

10.I understand that I am not able to supervise as an SPT Supervisor unless I am certified to do so.

I understand

I do not understand