Read Create_Your_Future_Application_Form.pdf text version

Overlap College `Create Your Future' Application Form

HOW TO COMPLETE THIS FORM

1. 2. 3. 4. 5. 6. Please complete this application form in full. If you require more space than is provided in each box, use page 4 to add further detail. Read the terms and conditions of The Overlap College on page 3. Sign the application to confirm that you agree with the terms and conditions. Email a scanned copy to [email protected] or post to the address below. Upon receipt of your application and payment, you will be sent a welcome letter and invoice.

PERSONAL DETAILS

Full Name Company Name (if relevant)

Address Postcode Billing Address (if different) Postcode Date of Birth

Email

Daytime phone

Mobile phone

Do you have any special needs that we need to know about?

If English is your second language, please describe your level of competence.

How did you hear about Overlap College?

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Overlap College, PO Box 58, Hornsby, NSW 2077. ABN 19 103 772 185. Tel: 1300 OVERLAP. Email: [email protected]

PERSONAL EXPERIENCE, HEALTH AND INTENTIONS

What is your current occupation? Employer Name

Briefly detail your life experience ­ marriage, parenting, career change, leadership roles, travel, working with kids etc

What do you intend to accomplish by participating in this program?

Have you previously undertaken any personal development work (leadership courses, therapy, self development workshops, counselling, energy work etc). Please detail.

This course may not be suitable for individuals with serious mental conditions, disorders or problems. We take your wellbeing and our work very seriously, so please advise us if you've ever been diagnosed with depression or taken any prescribed drugs for mental health, so we can discuss whether or not the course is right for you. We have a wide network of professionals that we can often connect you with, if we agree there isn't a fit and you'd like to seek a different type of support.

Please tick the box if you'd like to discuss this with us. Please note that anything which you share, will remain 100% confidential and will not be disclosed to others without your prior agreement.

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Overlap College, PO Box 58, Hornsby, NSW 2077. ABN 19 103 772 185. Tel: 1300 OVERLAP. Email: [email protected]

PAYMENT AND LEGAL AGREEMENT

Tick which course(s) you are attending

Create your future level 1

August 3 ­ August 10. $300 deposit & $590 balance is payable within 2 weeks of start date.

$890

Level 1 and 2 combo

$1600

August 3 ­ September 7. $300 deposit & $1300 balance is payable within 2 weeks of start date.

Create your future level 2

August 31 ­ September 7. $300 deposit & $590 balance is payable within 2 weeks of start date.

$890

Tick which payment method

Electronic bank transfer to:

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Soup Life Coaching Pty Ltd Account 256 321 BSB 032 096

(State your name as reference)

Cheque made payable to: Soup Life Coaching Pty Ltd

Mastercard Card number Name on card Expiry date

Visa . . .

CCV

THE OVERLAP COLLEGE TERMS AND CONDITIONS

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. The Overlap College is a trading name for Soup Life Coaching Pty Ltd (ABN 19 103 772 185). All deposits are non-refundable (except in extreme circumstances, such as illness and where proof can be supplied). All payments must be received in full 2 weeks prior to the program commencing. All credit card payments incur a 3% merchant fee on top of the rates listed above. If you can't attend the program dates above, you can move to a future program (at least 3 weeks notice is needed to avoid any additional charges). Date changes within 3 weeks of the program commencing, will incur a 50% charge for the total cost of the course(s). The other 50% will be kept in credit to be used against future courses. Each level of the program includes GST, 25+ hours of face-to-face workshop training and your workbook. The program does not include meals, parking, or additional coaching outside of the program times. The copyright and ownership of all materials remains with Overlap College. You are not allowed to use the tools and materials for any other use, such as teaching or coaching other people. You are not allowed to distribute the tools you receive on the program to other people. Overlap College will not disclose any personal information about you to any other party, except when required to do so by law. You will not disclose any personal information about the teacher, associates, volunteers or other students, which you hear in the program, to any other party, except when required to do so by law. You agree that this program may stretch and challenge you on a mental, physical and emotional level. You agree that you are making the choice to attend this program voluntarily. If you are not willing to experience any powerful emotions, which may arise as a result of undertaking this program, you are strongly advised not to participate in the program. You agree that if you have previously experienced any mental health problems, conditions or disorders, or are taking any prescription medications that you will discuss this with an Overlap College employee before the course starts. In certain cases, where necessary, you may need to obtain written authorisation by a suitably qualified medical professional to attend the program. Program information about what is involved in the program can be supplied. You agree to take full responsibility for your own experience throughout the program and in any instance where you may feel unsafe, or do not want to proceed with any of the program practices, you will advise the teacher. You may leave the program at any time. Refunds are not given, except in extreme circumstances such as illness of the student or immediate family member (proof will be required to qualify the refund). You will not hold Overlap College or Soup Life Coaching Pty Ltd, or any of it's employees, associates or volunteers liable for any loss or cost or damages incurred by you in the event of any physical, emotional or mental stress, distress, injury or ailment caused by attending this program, or by applying any of the theory or tools taught on the program. You agree to indemnify Overlap College and Soup Life Coaching Pty Ltd from any such claim, demand, cause of action, verdict, judgment or damages, losses, expense or costs in the event of any such incident. Your email address will not be used for any other reason, other than to contact you about the program you are attending and send information about future Overlap College programs. If you would prefer not to receive information about future Overlap College programs tick here .

16. 17. 18. 19. 20. 21.

I agree to Overlap College Terms and Conditions detailed above. NAME SIGNATURE DATE

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Overlap College, PO Box 58, Hornsby, NSW 2077. ABN 19 103 772 185. Tel: 1300 OVERLAP. Email: [email protected]

EXTRA SPACE FOR FURTHER DETAIL

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Overlap College, PO Box 58, Hornsby, NSW 2077. ABN 19 103 772 185. Tel: 1300 OVERLAP. Email: [email protected]

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