Student Re-Enrollment Form

First Name *

Last Name *

Student's PHYSICAL Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email Address *

What is the username you created to log in to emotionallysensitive.com? *0 / 1

I understand that DBT Path does not offer therapy, counseling, or crisis intervention and that I must seek these resources locally, as needed. *Yes, I confirm

I understand that this class is a psychoeducational, peer-led, holistic, DBT-informed course, is not a replacement for professional psychiatric treatment or services, and that any course I take at DBT Path is not intended to diagnose, treat, or cure any illness or condition. *Yes, I confirm

Upon re-enrollment, I allow DBT Path to send me class-related emails each week, which may include marketing materials. I understand that can unsubscribe at any time by using the unsubscribe link that the bottom of one of those emails. I understand that unsubscribing from emails doesn't drop me from the course. *Yes, I confirm

Signature *