This course application is required for in-person courses only.

Contact Information

Class Information

arrow&v
arrow&v

Emergency Contact

Personal Information

Confidential Medical History

Some of these courses can be physically and emotionally demanding.  A Little Oneness Therapy will try to accommodate all people regardless of physical disability whenever possible, however we must have complete disclosure of all physical and mental conditions prior to the course.  This will allow us to prepare and to provide all participants with the safest environment.  If you are under the care of a health care professional for a current condition, we require that you consult with them first to assure that our courses are safe and suitable.  All participants must continue to take any prescribed medications or regiments by their health care provider for the duration of the course.

arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v

We will try to accommodate non-life threatening food allergies, sensitivities, intolerances, and restrictions.  However, we may not be always be able to meet your dietary needs.

arrow&v
Check all conditions that apply:
arrow&v
arrow&v

Confidential Psychological Profile

arrow&v
arrow&v
arrow&v
arrow&v
arrow&v
arrow&v

Lifestyle

arrow&v
arrow&v
arrow&v

A 4-day fast will be part of the course 'Purpose,' provided a health care professional has permitted it.  A fast is not part of any other course.  We can accommodate those unable to fast.  

arrow&v
arrow&v

PARTICIPANTS RELEASE OF LIABILITY

I affirm that any confidential information, which I have provided, is accurate and complete.  I understand that failure to disclose this information could affect my own safety and the safety of those around me, and I agree to hold A Little Oneness Therapy, LLC harmless if full disclosure of a preexisting medical condition has not been provided. In the event of illness or injury, consent is hereby given to provide emergency medical care, hospitalization or other treatment, which may become necessary. I understand that parts of A Little Oneness Therapy, LLC courses may be physically and/or emotionally demanding. I agree to accept full responsibility and assume all risks, including those caused by acts of God, injury, death, and/or loss to my person and/or property knowingly and voluntarily, realizing that A Little Oneness Therapy will take all reasonable precautions to minimize these risks. 

​ I am aware that the services and products offered at A Little Oneness Therapy, LLC are not a replacement for psychological treatment.  I am aware that I am required to seek medical attention if I am dealing with a medical issue and consult with my health care provider about my participation with A Little Oneness Therapy, LLC services or products.  I am aware, A Little Oneness Therapy, LLC does not do assessments, provide treatment plans, or monitor care.  I understand that I am required to maintain any treatment plans and prescriptions as prescribed by my health care provider.   ​

I knowingly, voluntarily, and irrevocably waive any and all past, present, and/or future injuries, death, or loss, including those caused by acts of God, received while participating in activities conducted by A Little Oneness Therapy as a student, participant, spectator, and/or visitor, or in any other manner or form, taking part in the exercises, practices, excursions, and/or demonstrations. I certify that I am physically, mentally and emotionally capable to participate in the program I have applied for despite the rigors and dangers inherent in such a undertaking. I acknowledge that recording the course is strictly prohibited. 

​No refund is given for anyone who chooses to no longer participate.  Payment in full, is required at least 24 hours prior to course start date.  Any late payments will void application and participation in the course.  An invoice will be sent to your email if payment is not received by the due date.  You will also receive a 'Welcome Letter' stating details regarding your specific course and how to prepare.  This will include all travel details for in-person courses.

​Enrollment in a course is not considered complete until application is filled out in its entirety, full payment is received, and a 'Welcome Letter' has been issued to the participant.  Anything missing from the application process is considered incomplete.​

​I understand that prices, policies and course dates are subject to change without notice, and that A Little Oneness Therapy, LLC is not responsible for any nonrefundable airfare or expense incurred in relation to taking the course at anytime. My signature below indicates my acceptance of these terms and my desire to participate in A Little Oneness Therapy, LLC course.

PRIVACY STATEMENT

A Little Oneness Therapy, LLC respects your privacy. The contact information you share with us is never shared or sold to organizations outside of A Little Oneness Therapy, LLC. This information is for the exclusive use of A Little Oneness Therapy, LLC.

All application information including medical and personal, is held in the strictest confidentiality and protected under the full extent of the law. Any information requested is to help aid guides in maintaining your safety, your health, and to best meet your needs.

By signing, you are agreeing to these terms.

Application Submitted Successfully

Almost Done!

In-person courses require full payment at the time of application.  'Purpose' is suggested donation but requires a $100 deposit to cover costs in preparation.  Any donation can be made in person and assures the sustainability of the program.  Click here to pay deposit.  Your application will be considered incomplete without payment.

Course Application