REGISTRATION FOR SELF HELP COURSES
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Please fill out the form below to register for self help courses.
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*Name:
*Email:
*Address:
Telephone:
*Birthdate
Occupation
Spiritual Background
*What do you hope to receive through taking this course?
Have you ever had counselling?	Yes No
Details of Counselling	(if answered yes above)
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*CONFIDENTIALITY AGREEMENT
I am aware that self help courses may involve me sharing some personal information with the counsellor as I complete the course exercises.
I am aware that Carolyn Waddell is a counsellor, and that all personal information I share with her in the process of working on my self help course is confidential. I am aware that this confidentiality extends to all issues except those which Carolyn Waddell is required by law to report.
I am aware that Carolyn Waddell works with a team, for my benefit and her own support and accountability. I am also aware that the limited information shared with team members is completely confidential between the people involved.
I am also aware that all matters of confidentiality and professional ethics will be respected in these consultations and supervisory process.
Therefore, I give my permission to Carolyn Waddell to discuss my information in confidence with her supervisor and the professional team.
I agree I do not agree
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Please choose a user name and password to use for accessing the "Members" section on the website. If you do not choose a password, one will be created for you.
*User Name
Choose Password
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Please check the course or courses you are registering for.	Relationship Reframe (Learning general relationship skills) = $80.00 CAD Marriage Relationship Reframe (Marriage enrichment and conflict resolution) = $80.00 CAD Family Relationship Reframe (Parent, child, family focus) = $80.00 CAD Reframing Your Family Tree (Addressing generational and extended family issues) = $80.00 CAD Gentle Care Bible Basics (Learning how to apply Biblical principles to living life) = $80.00 CAD
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*** Remember to pay the course fee at http://www.gracecounselling.com/store.htm or as arranged with the counsellor.***
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Would you like more information on receiving counselling? Please check the type of counselling you are interested in.	Online Counselling Telephone Counselling Face to Face Counselling Intensive Retreat
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*required field
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Please click submit and return this form to me. I will reply to you shortly. Thank you.
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Note:  If you have not received a response from the counsellor within 72 hours, please email me at info@gracecounselling.com.