Father Wounds Registration

You are registering for the In-Person Father Wounds Event. Which date are you registering for? *

Name *

First

Last

What is your age range?

Address *

City *

State *

Zip Code *

Email *

Phone *

What pronouns do you prefer? *

What name do you wish to have on your name tag?

Have you taken ever participated in another Heart of Now event? If so, please describe.

Do you have any emotional or cognitive diagnoses? (such as ADHD, PTSD, bipolar, schizophrenia, depression...) If so, tell us how this affects you and how you manage it.

Are you on any mind or emotional altering prescription drugs? If so, what is your experience with this and how does it affect your life?

We encourage you to be sober for this event so that you can accurately feel your body sensations. Do you have any regular use of, or addictions to, substances that may get in the way of you being present during the weekend? Alcohol, sugar, caffeine, marijuana, opiates, recreational drugs, etc... Please explain how this might affect you.

Are you diabetic? If so, what do you need to manage it at our event?

Do you have any other medical or physical issues that we should know about?

Would you prefer to sit on the floor on a backpack or in a chair?

Tell us a little bit about your interpersonal growth experience. Include other types of workshops or trainings you have been through or any spiritual or meditational practices you might have.

How is your support system in your life? Do you have people that you connect with on a regular basis?

Briefly, tell us a little bit about how your relationship with your father is now and how it was growing up?

What do you feel gets in your way of living your life to your fullest potential? How do you get in your own way?

What do you hope to get from this workshop?

What are some of your dreams and passions?

Price: $255-$555 sliding scale. Please pay what you feel is right considering your financial abundance in life at this time. If you are in a place of abundance and want to help others that can not afford this training you can pay above the price of the workshop and the extra funds will go into our scholarship fund. Please enter the total you will be paying on for this workshop in the space below. After you submit this form you will be redirected to PayPal for payment. If you want to pay in an alternative way please specify in the notes. After payment is received you will be officially registered and your space held for the upcoming event. If you are unable to pay the minimum for this event and really want to attend please include this in the comment section. Tell us what you can pay and when, and what your situation is. We can set up a payment plan that works with your needs.

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