TEACHER MASTER CHAMPION PRODUCTIONS

 8359 Beacon Blvd., Suite 322, Fort Myers, FL 33907  Office 239-939-GROW (4769) Fax 239-939-9890

www.tmc4.com 

Address: ______________________________City: _______________ State: ____ Zip: _________

Phone #’s:    Home: ____________________ Work: ___________________ E-Mail: ___________________

Course:

 ___CCC/CRC                                                     ___ FTCC (Family Team Coach Certification)

___ LOVE                                                              ___ LOVE IT (Prerequisite LOVE, JOURNEY, ALPs)

___ THE JOURNEY                                                ___ LCT (Prerequisite THE JOURNEY, ALPs, LIA & SENIOR LIA)

___ ALPs (Prerequisite THE JOURNEY)                           ___ OTHER __________________________

___ LIA (Prerequisite JOURNEY & ALPs)

 (Please Initial #1-11)   Course dates: _______________________ALI______Guest Event_______

 ___ 1. I agree to pay a tuition of $_________. I have paid a nonrefundable deposit of $__________ with this  Agreement. I agree to pay the balance of $___________ by ____________________.

___ 2. I paid my deposit by:   __ check          __ cash             __ credit

            Credit Card#: ____________________________ Exp. Date: _____________________

___ 3. If I cancel this agreement before the course date my tuition will be refunded LESS the deposit.

___ 4. If I cancel this agreement after the start of the course my entire tuition will be forfeited.

___ 5. This is advanced Personal Growth, There is NO MONEY BACK GUARANTEE, I understand that I am responsible for creating value for myself in the course.

___ 6. I agree to attend all the sessions and to be on time for all sessions.

___ 7. I agree not to take any non-prescription drugs or alcohol within 24 hours of any session.

___ 8. As a participant in the course I agree to keep information about other students confidential.

___ 9. I agree to keep any course material or processes confidential while sharing the value I received with others.

___ 10. Notice of cancellation: You may cancel this transaction within three-business days of the date you signed your contract without any penalty or obligation. In order to cancel you must mail, deliver or fax a signed and dated written notice of intent to cancel to TMC PRODUCTIONS. There are no refunds after starting a course.

___ 11.  Your non-refundable deposit is transferable to another course one time only by paying in full at the time of the transfer.

 INFORMED CONSENT AGREEMENT

 I understand this workshop is educational and not psychotherapy or a substitute for psychotherapy. I understand there is always the risk of emotional and/or medical contingencies in such a group experience. I assure the risk, by this consent, of any accident or injury to myself or inflicted by me during the workshop, and hereby release TMC PRODUCTIONS from liability therefore. If I have doubts concerning my ability to participate I agree to take responsibility for consulting with a medical doctor prior to participating in the workshop regarding potential, current, or past physical or mental conditions that I have or may have. If I have had serious emotional problems or have been hospitalized for emotional problems or I am under the care of a psychologist or psychiatrist, I understand that it is required that I attend the program only with the written permission of my therapist. TMC PRODUCTIONS reserves the right to refuse a person attendance to the workshop if in the opinion of TMC PRODUCTIONS that person is currently not physically or emotionally able to participate. Even though TMC PRODUCTIONS may refuse my admittance to the workshop I recognize that TMC PRODUCTIONS is not licensed or qualified to diagnose any medical conditions and is not responsible for my emotional or physical well being. By the signing of this agreement I hereby, recognize and affirm that I am responsible for my own mental and physical well being and I will continue to take responsibility for my own well being during the workshop.

 I hereby authorize the staff members of TMC PRODUCTIONS and/or any instructors to take any reasonable steps on my behalf in the case of accident, injury or illness, including but not limited to emergency first aids, doctor, nurse and/or ambulance services, etc. I agree to be liable of the cost of any such taken on my behalf, and hereby release TMC PRODUCTIONS from liability therefore.

 There will be no exceptions to these policies except those stated here in writing and approved by TMC PRODUCTIONS President or A signee. I agree to all the terms and conditions set forth:

 Student Signature: ______________________________________________ Date: _________________________