Divine Healing Training Level 1 – Enrolment Form (Concession)

Divine Healing Training - Level 1 Enrolment Form (Concession)

"*" indicates required fields

Are you new to the training or a repeating student?*

I'm new to the training

I'm a repeating student

A note regarding the Save and Continue Option*

There is a Save and Continue option at the bottom of this form in case you need more time to fill it in. Please be aware that your place is NOT SECURE until you have completed the form AND made payment (deposit or in full).

I am aware that my place is only confirmed when the completed form is submitted along with my payment (deposit or in full).

Contact Details

First Name*

Last Name*

Birth Certificate Name*

Include all names on birth certificate

Do You Have a Non-English Pronounced Name? Non-English Pronounced Name?

For all non-english names (including your birth certificate name and currently used name) it is ESSENTIAL to send us a recording of your names pronounced as they would have been by parents at the time of naming. When recording, say the name at normal speed once, then three times more slowly at the same speed. If you don't speak the language then please ask someone that does to do the recording. Use the software Vocaroo (link below) or Speak Pipe to record the pronunciation of all non-english names. Then copy the link and add it below.

Record Your Name Pronunciations Here using Vocaroo/ Record Your Name using Speak Pipe

Share your Vocaroo/Speak Pipe link here

Alternatively upload your MP3 here

Occasionally Vocaroo/ Speak Pipe doesn't work for people. In this instance you can record your voice and save it as a MP3 and upload it below.

Max. file size: 512 MB.

Your name as you would like it to appear on your training certificate*

Date of Birth*

Mobile/Cell phone number (inc country code)*

Landline phone number (inc country code):*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Time zone*

Email address*

Enter Email Confirm Email

About you

Medical History*

Have you had any operations, accidents, illnesses, medication (Including psychiatric history)?

Yes

If yes please explain

Present health and medication.*

Please describe your present health including any medication you are taking regularly.

Mother’s Birth Certificate Name and Date of Birth*

Relationship with mother*

Describe your relationship with your Mother – whilst growing up & how it is now.

Father's Birth Certificate Name and Date of Birth*

Relationship with Father*

Describe your relationship with your Father – whilst growing up & how it is now.

Gestation and Birth*

Please state how long you were in the womb for and what was the circumstances of your delivery (e.g. premature, method of delivery etc.)

Drugs*

Have you ever taken recreational drugs (if yes, list them all)?

Have you ever abused alcohol?*

Yes

If yes please explain

Have you ever smoked?*

Yes

If yes please give further details

Dental Work*

Have you had any major dental work?

Yes

Dental Work Explained

If yes, please explain what and when it was

Do You Recall Any Emotional Traumas?*

Yes

Emotional Trauma Explained

Please list all emotional trauma you recall

Do You Have Any Allergies?*

Yes

Allergies Explained

Please list all allergies

Do You Have Any Addictions/Cravings?*

Yes

Addictions/Cravings Explained

Please list all addictions

Your Environment*

Describe your present home and family environment.

Your Occupation*

Describe your main occupation. Are you happy in it?

Diet*

Describe your diet.

Activity and Exercise*

Describe your level of activity and exercise.

Sexuality*

Do you feel your sexuality is flowing or is blocked in any way. Now or in the past?

Menstrual Cycle*

Describe your Menstrual Cycle (e.g. Regular, irregular, PMS). If this question does not apply please write N/A

Practices*

Do you meditate or have a spiritual practice?

More About You

What brought you to this training?*

Tell us a little about what you are hoping to achieve and what are your objectives with using this training in the future.

EQ-Emotional Intelligence*

How well can you feel the full range of human emotions e.g. fear, anger, despair, grief, anguish, terror, guilt, shame, hopelessness, rejection, abandonment, mistrust, unworthiness

Relevant experience*

Tell us more about your background in terms of healing, facilitation, teaching, training and/or experience in delivering these services.

Payment and T&C's

I will pay the agreed upon (by myself and Nicolas David Ngan) concessionary price in full before the commencement of the course*

I agree to the above statement

I agree to commit to the full training*

I agree to the above

I agree to attend all training sessions.*

I agree to the above

I agree that the content of all the healing sessions and processes, everything shared by teachers and students is strictly private and confidential, and not to be shared outside of the training, in order to create a safe space for all concerned.*

I agree to the above

I agree that if I withdraw before the training commences and have not paid the balance of the course fees, only the deposit is non-refundable. If I withdraw after I have received access to the downloadable course manuals, the full course fees are non-refundable, but may be transferred to a future training within two years.*

I agree to the above

Marketing

Where did you hear about this training?*

I was Referred by Someone

Soul Contract Reader software

Center for Conscious Ascension website

Center for Conscious Ascension newsletter

Center for Conscious Ascension social media (facebook or twitter)

What is the full name of the FIRST person who referred you and the DATE they did so?*

Would you like to join the Center for Conscious Ascension Mailing List?*

No need to complete if you are already subscribed.

Yes

Divine Healing Training Level 1 – Enrolment Form (Concession)