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YuWith 愈·未知
Traditional Astrology
The WITH Room
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Name
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Email
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Email
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Time Zone
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License/discipline
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Clinical Hours
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Main practice setting (private practice, agency, higher education, etc.)
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Private practice
Agency / community mental health
Higher education
Hospital / medical setting
Group practice
Other
I’m currently in individual therapy and/or individual supervision or consultation
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I’m currently in individual therapy and/or individual supervision or consultation
Step and Payment
What draws you to this group? (2–3 sentences; optional: a money moment you’re working with)
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Payment and Cancellation
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I consent I fully understand the following:
50% of the fee (150USD or 1010RMB) is due when you register to hold your place. The remaining 50% (150USD or 1010RMB) is due on the day of the first session. If you cancel 10 or more days before the first session, you’ll receive a 90% refund of what you’ve paid (i.e., 135USD or 909RMB minus processing fee) . Cancellations made less than 10 days before the first session are not refunded. Live sessions are never recorded, to protect the privacy of the group. As a founding cohort member, you will receive any additional course materials in the future at no additional charge for a limited period.
Educational Purpose and Disclaimer
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I consent I understand the following:
This program is offered for educational purposes, to support self-reflection and professional development. It does not constitute legal, ethical, financial or tax advice, and it is not therapy or a substitute for clinical supervision. Laws, regulations and professional standards differ by jurisdiction and license. Participants are responsible for consulting their licensing board, professional ethics code and applicable laws and regulations, and where needed a qualified attorney or other professional, before making decisions about their practice.
Confidentiality
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I consent I understand the following:
What’s shared in the group stays in the group. Participants agree not to record, photograph or screenshot sessions, and not to share other members’ names, identities or anything they disclose. You’re welcome to talk about what you learned, without identifying anyone. Course materials (slides, worksheets, readings and prompts) are for your personal use and may not be copied, distributed or used to teach others without permission. While the facilitator holds these agreements, the facilitator cannot guarantee that every participant will keep them, so please share at the level that feels right for you. Breaking these agreements may result in removal from the course without a refund.
Next Step
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I consent I understand the following:
Submitting this form does not confirm your acceptance into the founding cohort. I’ll review your application and follow up. Your place is confirmed once your deposit is received.
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