Rage Circle Registration — Wish You Knew

Rage Circle Registration Form

Rage Circles are a space to honor the rage we carry. Perhaps society has scripted us that rage/anger/fury are bad so we don’t allow ourselves to feel them. Perhaps because of identities we hold, showing rage literally puts our lives in danger. Perhaps we were taught anger is the only emotion ok for us to express. Whatever script we were fed, this process, inspired by restorative justice circle process, is a space to honor those emotions and, hopefully, start to move through and release some of what is building up. We are not here to fix, or solve, or save, or soothe one another, simply to help hold the enormity of the rage.

Name

First Name

Last Name

Organization/Group Name (if your employer shared this opportunity with you please list their name)

Phone Number

Please list any experience you have with Restorative Justice practices, circles, or other group healing work.

What goals do you have for joining this space?

Registration and Payment Information

Group spaces are limited. You will receive a confirmation email upon registration confirming your space, if for any reason your plans change, please let us know ASAP. Cancelation prior to 48 will receive reimbursement minus any processing fees, after 48hrs no reimbursement will be possible, reschedule may be possible in limited circumstances. Registration payment via Zelle or Check is $60. *karen@wishyouknew.net Registration payment via credit card is $62. If none of the times listed work in your schedule, please don't hesitate to email Karen@WishYouKnew.net requesting specific times or dates.

June 8 @ 3pm ET (2hr Session)

Do you have any identities you would like to share with me and/or any accommodations that would be helpful to you when entering a Zoom-base, group sharing space?

Who can I thank for sending you my way?

Please also mention any discount code you may have here.

Emergency Contact Name

Emergency Contact Information: While rage circles are meant to be a space where we process through what and as much as we can while taking responsibility for our emotional and mental safety, challenging emotions may come up. In the event you are having trouble regulating or something intense is triggered in you, it is required that you provide the physical address where you will be at the time of the event and an emergency contact we can reach on your behalf. This person should be geographically close to where you will be.

By checking the following box, you acknowledge the purpose of the emergency contact and consent to them being contacted if needed.

Yes, I agree and Consent

Emergency Contact Name:

Emergency Contact Relationship to you:

Emergency Contact Phone Number:

Address for the physical location where you will be at the time of the circle (Number, Street, City, State/Province, Country, Zip Code)

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