Please complete form in full to be registered in the group. This information helps me learn a bit about you and completes your registration.

As your facilitator for this group, I am continuing with an extensive training process with The Daring Way™ team to understand and teach this curriculum as well as am a Registered Psychotherapist. Your willingness to answer the questions below will help us best assess your readiness for a group experience such as this. Thank you so much for your cooperation in answering the questions.

Your participation in the group will be confirmed upon the receipt of your payment/down payment along with the submission of Group Readiness Form and the Informed Consent Form found under the "ABOUT" tab. If filled out here, this form will be electronically submitted.

* Indicates required field

Address *
Phone *
Have you ever seen a mental health professional (Psychiatrist, psychologist, marriage and family therapist, social worker, counselor?) *
Do you have a therapist you could work with if something came up in this workshop requiring individual attention? *
Are you currently taking any medication for mental health issues? *

Thank you so much for providing this information! I will review the information you provided and follow up with you to confirm your registration.

For questions or more information you may contact me at: