Name
Address (including Post Code)
Telephone Number
Mobile Number
Email Address
Date of Birth (DD/MM/YYYY)
Occupation/Previous Occupation
1. Have you listened to the Part 1 of the Lightning Process audio programme or read the Introduction book? YesNo
2. Are you willing to attend and participate in the discussions, training and coaching sessions? YesNoMaybe
3. Personal History
How would you describe your illness/symptoms/issues? (Include medical name/diagnosis if relevant)
When did your symptoms/issues begin?
Date of Diagnosis (if relevant):
How did they start?
How has this affected your life?
Do you need wheelchair access to get to the venue? YesNo
4. Do you feel you can influence your own health? YesNoMaybe
5. Do you believe you can get better/resolve your issues? YesNoMaybe
To help me assess your suitability for the seminar please tell me if you have any medical or mental health issues that you have not yet mentioned on this form. If so,please list them:
6. Your Lightning Process Course
What do you hope to achieve from doing the course?
What would you love to do with your life?
7. Have you applied to take the training before? YesNo
8. I would like to be accompanied at the seminar YesNoMaybe
As space can be limited on some courses, please discuss availability with your practitioner during your phone call, if you would like to be accompanied. This person will need to complete a separate Learning Facilitator form.
9. Confidentiality
Do you agree to maintain confidentiality with regard to personal information shared by others during the training? YesNo
10. Payment Details
The training fees for taking the Lightning Process training with Theresa Jauregui are £695 for group training or £1350 for 1-2-1. This includes pre-course support or coaching, your assessment, 3 half days of training and course materials, and 3 hours of follow-up phone calls (to use within the year following training). Once you have been accepted onto a course, a 50% deposit is required to secure your place. The balance is due a week before the course. All payments can be made by BACS.
11. Training Agreement
You should only sign this application form if you agree to the terms and conditions on the following page and to the following statement:
“I understand that the Lightning Process is a training programme. Its purpose is to train me in the tools of the Process, and I realise that simply attending will not guarantee me any results. I recognise the changes I want can best be obtained by fully participating and engaging in the seminars and continuing to apply it after. I am ready and committed to do this.”
By ticking the box below, you agree to the T&C and the statement above: I Agree
Emergency Contact
So that we can contact someone close to you in the case of an emergency please provide: Emergency Contact Name:
Emergency Contact Phone Number:
The following must be completed if you are under 18 years of age
If you are under 18 years of age please ask your parent or guardian to read through the form and if they also agree to the terms and conditions, for them to sign the form too.
Relationship to applicant
Conditions of Payment
Once paid you have seven days to cancel your booking and receive a full refund if training has not commenced. After this fees cannot be refunded in the event of a cancellation on your part, or a failure to complete the training. This is because I run small group trainings with limited spaces; if you take up a space and cancel, no one else will be able to fill it once the course starts. However, if you cancel at short notice and we are able to fill your space your fees will be refunded. I reserve the right to terminate your training if we feel your continued participation would be unhealthy or unhelpful for you or another member of the training group. Your fees will not be refunded in these circumstances.
Cancellation of Seminars
On occasion unforeseen circumstances may make it necessary for me to cancel a seminar and accordingly we reserve the right to cancel seminars where appropriate. In such circumstances you will be given as much notice as possible and I will either refund the full seminar fee or, if you request, move the training to an alternative date.Liability for any losses other than the seminar costs will not be accepted.
Ownership
All documents you receive as part of your training constitute the intellectual property of Phil Parker and are not to be reproduced, sold or distributed in anyway.
Copyright Notice
The purpose of the Process is to apply it to resolve your personal issue/s. Participation in the Process does not amount in any way to permission to reproduce or train others in any of the techniques or materials (including graphical images, text, audio or visual presentation) that are demonstrated or provided.
Data Protection Policy
The Head Office for the Register of Lightning Process Practitioners is registered with the information Commissioners Office (ICO) and all information is held in accordance with the General Data Protection Regulations 2016/679 (GDPR) and Data Protection Act 1998. Please refer to the Lightning Process Head Office Privacy Policy here: https://lightningprocess.com/privacy-policy
You can decide to have your attendance certificate logged, together with your name, certificate number and email address with the Lightning Process Head Office. This will:
If you would like this option, please check this box. Yes
In addition to the logging of your details for the purposes outlined above, we would also like to occasionally inform you of relevant developments in the Lightning Process ® and its associated programmes. This is an optional service. Your details will never be passed on to anyone else for any reason. Please check this box if you wish to receive occasional and relevant correspondence from us about this. Yes
In order to conduct further research into the Lightning Process we would like to contact you at regular intervals to monitor your progress. We will not use any details by which you may be identified in any statistics that we produce. Please check the box if you agree to this. Yes
Thank you for filling in this form, I’ll be ringing you shortly to discuss your training with you! I will confirm I have received your application by email.
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