Personal Family Constellations Workshop - Participant Questionnaire

Thank you for your interest in being a participant at an in-person Family Constellations workshop. Please fill out this brief form to complete your registration.

Name

First Name

Last Name

Date of Birth

YYYY

Have you participated in Family Constellations before?

Yes

What motivated you to participate in a Family Constellations Workshop with me?

1) I agree to take personal responsibility before, during and after this Family Constellation Workshop. Family Constellations can be emotionally confronting. Especially within a group of strangers as representatives. This method may be a challenging and/or unsuitable therapy for people with clinical mental health conditions (such as schizophrenia and/or bi-polar disorder). Please disclose any mental health conditions to Brooke, prior to the Family Constellation Workshop. 2) I am a willing, healthy and consenting adult participating in this modality. I agree not to participate under the influence of substances. 3) I understand that there are no guaranteed outcomes offered. 4) I agree to maintain confidentiality regarding any information shared by other participants during this workshop. 5) Participation as a representative is Free, however I commit to attending the agreed date that I have confirmed, to ensure the constellation can go ahead. I understand that the facilitator reserves the right to offer my place to another willing representative if I do not attend a workshop I had previously agreed to attend. By selecting Yes below I agree that I have read and understood the above terms of service and I agree to the conditions outlined for a personal Family Constellation Workshop provided by Brooke Lumsdaine.

Yes