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Application for the Phil Parker Lightning Process Training with Jenny Oliver

Application Form

Please read the Terms & Conditions before filling out this form.

1. Personal Details

Name

First Name

Last Name

Birth Date

YYYY

Gender

Occupation / Most Recent Occupation

Mobile and/or Home Phone Number

Address

Province

2. Personal History

Thank you for sharing details of your medical history so that I can be prepared to give you necessary help and support.

How would you describe your illness/symptoms/issues/stuckness?

Please include medical name and diagnosis if relevant.

Diagnosing consultant or doctor (if relevant):

When did your symptoms/issues begin?

Please include medical name and diagnosis if relevant.

Do you know of someone who has used the Lightning Process to recover their health?

How did you hear about the Lightning Process?

How did you hear about Jenny and Monarch Life?

Accessibility

Please tick if you require wheelchair access at the course venue.

Yes, I require wheelchair access.

Support person

Please tick if you would like to bring a support person with you. A support person is an individual who attends but does not complete the training course. There is no extra fee for your support person.

Yes, I would like to bring a support person with me.

3. Application Questions

Do you feel you can influence your health?

Do you believe you can get better/resolve your issues?

When you resolve your issues, what would you love to do with your life?

Please list a minimum of 3 specific things

4. Confidentiality

Do you agree to maintain confidentiality with information shared by others during the training?

Note: We do not 'share' our issues around the group

Yes, I agree.

5. Terms & Conditions

Agreement

If you are under 18 your parent or guardian will need to read and accept the Terms and Conditions on your behalf.

I have read and accepted the Terms and Conditions.)

Name of parent or guardian:

If applicable.

First Name

Last Name

As a parent or guardian, what is your relation to the client?

If applicable.

I would like to have my attendance certificate logged with the Lightning Process Head Office:

I wish to receive occasional and relevant correspondence about developments in the Lightning Process:

I give my permission to be contacted at times for the purpose of further research into the Lightning Process:

What future course dates would you prefer?

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Application Form

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