Application Form for The Phil Parker Lightning Process® Training with Theresa Jauregui

    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.

    Name

    Relationship to applicant

    By ticking the box below, you agree to the T&C and the statement above:
    I Agree


    Terms and Conditions

    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:

    • Ensure that it can be replaced in case of loss
    • Help us with our research and statistics
    • Help us to check that you have received the high standard of care we expect from members of our register

    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.