Motherhood Form | Arise Therapy & Well

SIGN UP if you're ready to trade lonely and unsupported for lifted and surrounded!

Find all the details and information below.

First name

Last name

Email

Age

I am a resident of Manitoba

Please share briefly why you want to join an ARISE: MOTHERHOOD online group:

Weekly Availability

Tuesdays at 10:30 am

Tuesdays at 1:30 pm

Fridays at 10:30 am

Please share the ages of your children:

Please share your Facebook profile name:

Topics of Interest, please select your top 3:

Other; what doesn't get talked about that this group could provide space for?

Following the 6 week online group, will be an opportunity for an in-person meet-up or retreat. This would be at an additional expense to the 6 weeks and include nourishing food and restorative accommodations at a location near Winnipeg, MB. Please indicate your interest and availability. More information to come! Please check all that apply.

I am available the morning of Saturday, November 30th

I am available the afternoon of Saturday, November 30th

I am available the evening of Saturday, November 30th

I am interested in a meet-up (~3 hours)

I am interested in a retreat (Saturday evening to Sunday noon)

I am not interested in an in-person meet-up or retreat

The investment to join the 6 week group and online Facebook community is $300 CAD and includes:

a weekly facilitated 75 min online group for 6 weeks
access to private online Facebook community

Your spot will be secured upon confirmation of payment.

Details for how to pay will be provided in a follow up email to this form.

I understand that by signing below, I am confirming the information I have provided to be true and accurate.

Signature

Good for you, taking this step FOR YOU towards more connection!

Us moms often talk about what we need more of, I'm so glad you're ready to make it happen.

Talk soon!