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Registration & Informed Consent - Light It Up: Blazing The Bullshit

Personal Information

Event Considerations

Are you 18 years of age or older?

Are you 18 years of age or older
A
B

Have you previously attended an art therapy or expressive arts workshop?

Have you previously attended an art therapy or expressive arts workshop?
A
B

Are you a military member?

Are you currently a military member
A
B
Use Code: 22ADAY to Save At Checkout!

Please briefly describe your motivation for attending this workshop and any specific goals you hope to achieve:

Is there anything else you would like us to know or any special accommodations you require? (e.g., accessibility needs, etc.):

Do you currently have a therapist or a counselor?

Do you currently have a therapist or a counselor?
A
B

If yes, may we contact your counselor about your participation in this event?

If yes, may we contact your counselor about your participation in this event?
A
B

If yes, please provide your therapist's contact information (Name, Email, Phone), and indicate whether you grant permission to reach out to them:

Untitled multiple choice field
A
B

If you don't have a therapist but are open to receiving referrals, please indicate below:

If you don't have a therapist but are open to receiving referrals, please indicate below:
A
B

Emergency Contact

Do you give TraMck Connections, LLC permission to contact person listed above in the case of an emergency?

Do you give TraMck Connections, LLC permission to contact person listed above in the case of an emergency?
A
B

How did you hear about The Light It Up Event?

Agreements & Disclaimers

- "Light It Up" is designed to provide a therapeutic and supportive environment. Please be aware that this event may involve emotional exploration and expression. It's important to consider your emotional well-being when deciding to attend. Your safety and well-being are our top priorities. If you have any concerns or questions, please feel free to reach out to us at [email protected] or by calling (918) 418-4700.
- “I understand that "Light It Up" is not a replacement for professional therapy or counseling services, and I am responsible for my emotional well-being during and after the event.”

- “I agree to respect the privacy and boundaries of fellow participants and maintain a supportive and non-judgmental atmosphere.”


- “I understand that photographs or video footage may be taken during the event for promotional purposes. If I prefer not to be photographed, I will inform the event organizers.”


Consent

By registering for this event, you consent to receiving event-related communications and updates, acknowledging and agreeing to disclaimers and agreements, and identifying that you are at least 18 years of age with capacity to consent to the terms of this registration.

Signature & Registration Submission

Signature