CTA Workshops "Agreements for Registration" Form

This program is intended as a personal growth experience and should not be looked upon as a substitute for psychotherapy. It can involve dramatic experiences accompanied by strong emotional and physical release. This program is not appropriate for pregnant women or for persons with cardiovascular problems, sever hypertension, sever mental illness, recent surgery or fractures, acute infections, illness or epilepsy (see Contraindications). If you have any doubt whether or not you should participate, consult your physician and/or therapist, as well as the facilitator, well before attending.

1. I agree that my presence in this program indicates that I have considered the nature of the program and have chosen to participate on my own responsibility and at my own risk. I know of no recurring conditions, physical, emotional or mental, which suggest to me that I will be unable to successfully fully engage in this program.

2. I understand that this program may bring up unresolved issues or conflicts, either current or from the past, and I agree to be responsible for maintaining my well being while I work to resolve these issues.

3. I understand that this program is not therapeutic in design, intent or methodology, and that the facilitator(s) and any assistants may not be trained mental health professionals.

4. If I have complaints or problems with the delivery of the program or with any other aspect of my participation in this program, I agree to communicate those complaints directly to the facilitator and to work with them to resolve any difficulties.

5. I understand that, while I am free to share my experience of the program, the concepts, processes and material presented during the program are most effective when presented within the context of the program. I therefore agree not to communicate the content or processes of the program to any non-participant nor to present or use the material as my own.

6. I agree to hold all individual's experiences during the program as confidential and to create a safe environment in which my fellow participants may experience their own process.

7. I agree to let the leader lead. I further agree not to process other people or answer their shares or give them advice.

8. I understand that my uninterrupted participation is necessary for the successful delivery of the program and that the value I receive from the program will be largely a function of my commitment and participation. I therefore agree to arrive on time, return from breaks on time and remain through the entire program.

9. I agree to never become sexual with any participant from my workshop unless I have previously developed such a relationship with that person. This allows an extra level of safety for those who might have been sexually abused growing up and for all participants to explore non-sexual intimacy. Initial here _____. MORE

10. I declare that I am personally responsible for the results I create from my voluntary participation in this program.

Workshop Title__________________________________________________________________________
Signed ________________________________ Print name____________________________Date__________