Registration

First Name (required)
 Middle Initial
Last Name (required)
Address
Apt/Suite
City
 State
 Zipcode
Home Phone (required)
 Mobile Phone
Your Email (required)
Which class/event
 Have you paid?
 yes no
(payment must be received before
registration can be processed)
Comments
I have read and accept the terms of the registration Agreement (below)

REGISTRATION AGREEMENT

Professional Disclosure Statement
A biblical approach is taken in leading and ministering to the needs of the whole person, reflecting the love, mercy, and healing power of the Holy Spirit. Women in recovery from sexual assault (of any kind) are provided a safe, confidential place to share and work together for the healing of everyone, and is open to all women regardless of sexuality, race or creed. Our mission is to instill courage to heal from sexual wounds and confidence to grow spiritually and emotionally. Must preregister.

Participants Agree to the Following:
* I will attend all meetings, be on time, and contact group leader if unable to attend.
* I will let the leader know if I am unable to finish the class.
* I understand that first names only are to be used. No cross talking, which takes away full attention and respect from the leader. No children or unauthorized visitors are allowed in class. No tape recording. No disclosure of any group member to outsiders. No substance abuse on the day of meeting.
* Leader has the authority to remove any participant from the group if deemed necessary in order to maintain the integrity of the group.

(Registration is your acknowledgment of this Agreement)