Registration Application Form

Thank you for completing this form. If you are registering for a training intensive, we will be in contact with you to complete the registration process including payment.

First Name *

Last Name *

Phone Number *

Email *

Please select the core course you would like to attend:

EAFI 110 Dive in to Expressive Arts (Intermodal)	EAFI 120 Expressive Arts for Body, Mind, Spirit
EAFI 130 Scope of Expressive Arts	Other class or workshop Other class or workshop

What do you hope to gain from this workshop? *

Are you considering applying for the Certificate Training Program? *

Briefly list any prior or current experience with expressive arts or related practices: *

Prior experience with self‐exploration or inner process work: (please describe) *

Please describe any prior training in expressive arts: *

Do you have any special needs that you would like us to know about?

Anything else you would like us to know about you?

Statement of Informed Consent
By printing and signing below, you are indicating that you understand and agree.

I understand that I am participating in an Expressive Arts workshop or class. I understand that the Expressive Arts can be a very healing, powerful, and therapeutic experience, and that it is not psychotherapy. I am taking personal responsibility for my own well-being.

Print Name *

Signature (participant) *

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Date *

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