The completion of this form is the final step of the registration process. It must be completed to finalize your registration.

Name

First Name

Last Name

Home Address

Primary Phone

Secondary Phone

Is it OK to leave messages?

Yes

Email Address

What sparked your interest in the Daring Way™ group?

What connects for you from Dr. Brené Brown’s TED talks or books?

What would you like to accomplish in church leadership as a result of attending this offering?

In the retreat, there will opportunities to share with and listen to others. How do you imagine this will be for you? Please note, you share to the level with which you are comfortable.

What life transitions or issues are you currently navigating?

Do you have a therapist or counselor you could work with if something came up in the group requiring individual attention?

If not, would you like referrals to therapists?

What else would you like me to know about you?

Please list any dietary restrictions I’d need to be aware for planning purposes.

Thank you for submitting this information to complete your registration!

Sarah Ciavarri, M.Div., PCC, BCC, DTLF, President

Serving Minneapolis, St. Paul, the Twin Cities Metropolitan Area, Greater MN, and Beyond

952-210-7252 sarah.ciavarri@gmail.com

Registration Form

Daring Way™ Registration Information

Thank you for submitting this information to complete your registration!

Sarah Ciavarri, M.Div., PCC, BCC, DTLF, President