Your name Preferred Name/Nickname Date of Birth Your email Your Cell Phone Number May we text your cell phone? YesNo Preferred Method of Communication TextEmailPhone Call Street Address City, ST, Zip Emergency Contact Full Name Emergency Contact Phone Number Emergency Contact Relation FamilyFriend Age and Gender Agreement: By checking the box and submitting this registration, you agree that W.O.W. Sessions 2025 are specifically designed for adult women only and that you must be at least 18 years of age and legally capable of making your own decisions, having legal capacity and able to manage your own affairs without needing a guardian to make decisions for you. Do you agree that you are an adult female and are legally capable of making your own decisions? What personal goals do you have for participating in the group? Please summarize any additional information including questions and/or concerns you may have for the group facilitator. (Optional)
