Participant_Agreement.html

Participant Agreement

for

Inviting My Body to Each Day's
Happy Healthy Weight

facilitated by Jeanine DuBois

I ___________________________________________________________ (print participant name) understand that:

this workshop series is designed to assist me with healthy, happy habits, attitudes, and self-image and to release blocks which inhibit these

it is NOT meant to enforce or push any unnatural or arbitrary timeline for weight loss or gain

since a significant or rapid weight loss or gain or change in appetite can be an indication of a medical condition, I commit that (check one):

I have consulted with a medical practitioner regarding this issue within the last 15 months.
OR
I will consult with a medical practitioner by ________________________________ (date).

in order for all to receive maximum benefit from this series, I will meet with Jeanine for a private intake session (check one):

$60/hour (standard rate is $75/hour) including my first TAT^® experience
OR
if I have previously experienced TAT^® from Jeanine, the fee will be waived if our intake can be completed within 10 minutes

I am welcomed and encouraged to ask Jeanine any questions I have about the workshop series.

Session Participant: X____________________________________________________ Date____________________

Name (printed)_________________________________________________________________________________

Address_______________________________________________________________________________________

City___________________________________________________ State____________ Zip code _______________

Country________________________________________________ Phone__________________________________

Email_________________________________________________________________________________________

* * * * *

May I send you email updates about upcoming workshops or special rates? Yes No

session preparation: also sign TAT^® and Brain Gym^® Information and release forms

workshops and retreats

updated 2/19/2008

Compassion's Doorway