Couples Registration Form

Couples Registration

Person #1

Be as detailed as you can.

Person #2

Be as detailed as you can.

Business Details:

Family Details:

Person who shared Pathways with you:

Who told you about Pathways? We call these people Sponsors.

Emergency Contacts

Repeating Students Only:


Payment Information

By filling in my name and date below, I acknowledge that I have read, understand and agree to all of the above terms and conditions.

Medical and Psychological Information

Due to the participatory nature of the seminar, the following information is required to attend. This is done in order to provide the best learning environment possible for you and the other participants. Please answer the following questions by checking the appropriate response. Your answers are kept confidential except for possible disclosure to your physician, psychiatrist, psychologist or therapist, if applicable. If you have any questions or concerns regarding the following, please contact the Pathways office.
The Basic Seminar is based on an educational model, not a medical model. None of the Pathways staff are licensed psychiatrists or psychologists.