The Daring Way™ Registration

Thank you for submitting the form below. Please complete the * sections to provide the confidential information needed to complete your registration. The rest of the questionnaire is optional, however, your willingness to complete it will help us know you better as you embark on this journey. If you are registering as a couple, please have each person complete this form. Your participation in the workshop/group will be confirmed upon the receipt of your payment along with the submission of The Daring Way™ Registration and The Daring Way™ Informed Consent Form found here.

Name *
Name
Address *
Address
Phone *
Phone
Provider Support Phone Number *
Provider Support Phone Number
Would you like to be included on our e-mail newsletter? *
Workshop Attending *
Your guides for this workshops have completed an extensive training process with Dr. Brene’ Brown and her team to understand and teach this curriculum. Your willingness to answer the questions below will help us best assess your readiness for a group experience such as this. Thank you so much for your cooperation in answering these questions:
Have you ever seen a mental health professional (Psychiatrist, psychologist, marriage and family therapist, social worker, counselor)?
Do you currently have a therapist you work with?
Are you currently taking any medication for mental health issues?

Thank you so much for providing this information!