Name *

First Name

Last Name

Participation Agreement *

By checking this box, I confirm that Gary is not my counselor in the context of this event, and this event is not considered therapy of any kind. If the topics become overwhelming, I will seek mental health support outside this event.

By checking this box, I acknowledge that confidentiality cannot be guaranteed due to the inherent nature of group dynamics. I release Gary and Conachan Counseling, LLC from any liability for anything shared by other participants during the event or for any potential harm or distress it may cause to me or others.