Basic Leadership Training – Questionaire Form - Portal

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Full Name *

First

Last

Phone *

Email *

Date of Birth *

Gender

Address *

Address Line 1

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City

State

Zip Code

Name of the person that invited you to this training *

Welcome, please read the forms and answer all questions completely, even those that do not apply to you.

We have no way of knowing in advance if the training you are registered for is appropriate for you, but we understand that the people who benefit most from it are those who have had a certain measure of achievement, growth, knowledge, and success in different areas of their lives. This form allows us to better understand your physical and emotional health status.

This document will be kept confidential and will only be used in the event that a health situation arises during the course of the training.

Completing this questionnaire will help us determine if, at this time, given your health status, this training could benefit you.

INGENIERIA TRANSFORMACIONAL INC. is not responsible in case of misrepresentation or omission of the information required in this form.

All information contained in this application is protected by professional privilege and will only be used by your trainer and/or authorized personnel.

1. How many hours do you regularly sleep each night? *

3. Have you received psychological therapy or counseling during the last 12 months? *

4. Have you been hospitalized for any psychological or psychiatric condition during the last three years? *

5. Have you taken any type of medication in the treatment of emotional, psychological, or psychiatric conditions and ailments during the last three years? *

6. Do you consume any type of illicit drugs, or restricted medications without a medical prescription? *

7. Do you have any physical condition that requires any reasonable accommodation during the training? Please describe the condition and the type of support you require. *

8. Please relate any information related to your life experience that you consider important and that may be significant. (E.g., phobias, abandonment, deaths, divorces, and/or dissociative episodes.)

If you answered yes to questions 4, 5, and 6, we might recommend that you do not participate in the training.

We do not offer professional psycologycal assistance. If you still wish to participate, you would be assuming full responsibility for your physical and/or emotional health situation.

Select the option that applies to your situation *

It is my understanding that the financial investment I made for any of the trainings offered by INGENIERIA TRANSFORMACIONAL (TRANSFORMATIONAL ENGINEERING) is non-refundable. This investment can be transferred only to myself for the next two trainings starting from the original date on which I registered.

Therefore, I declare and ratify that I am over 18 years of age. I have understood all the recommendations.

I have read this document carefully and that I have voluntarily answered the questions honestly, completely, and truthfully, and therefore I take full responsibility for my participation in this training.

Signature

Clear Signature

Today's Date *

Release of Liability

Please sign and date this agreement once you have read all the points in this section.

Section I: Consent to Participate

1. I understand that this is a program based on educational experiences and personal events that may or may not support my personal growth. It is not intended to constitute psychotherapy, medical therapy, or a substitute for either.

The trainers are generally not licensed psychiatrists or psychologists. I understand that the training may include physical contact. For example, hugging. If I do not consent to this, I will let the trainer know my objection, before or at the moment the contact occurs.

I also understand that in several of the processes in the training, experiences are shared and that I may feel deep emotions and possibly emotional stress, anxiety, crying, physical discomfort, or exhaustion.

2. I have no doubt about my mental health, emotional stability, or physical ability to handle this training. Any doubts I may have had before making the decision to enroll were resolved by consulting a doctor, psychiatrist, or psychologist knowledgeable about the technology offered by INGENIERIA TRANSFORMACIONAL (TRANSFORMATIONAL ENGINEERING) and they have no objection to my participation in this training.

3. I understand that INGENIERIA TRANSFORMACIONAL, its employees, directors, agents, shareholders, contractors, representatives, and the team members who collaborate with this training are here to support me and are solely responsible for presenting the training offered by INGENIERIA TRANSFORMACIONAL in an orderly manner. INGENIERIA TRANSFORMACIONAL is not my fiduciary or guardian and I do not expect my training to be provided with the standard of care expected of mental health professionals.

If I feel mental or physical discomfort, or adverse effects during the training, it is my responsibility to inform the trainer or staff immediately. I understand that I am free to leave the training at any time or for any reason. If I feel that I need professional or other help, I assume full responsibility for leaving the training and obtaining professional help myself if necessary.

Section II Agreement Releasing Ingeniería Transformacional from Liability.

1. I am fully aware that participating in this training offered by INGENIERIA TRANSFORMACIONAL may involve certain risks.

I know and understand the scope, nature, and extent of the risks involved in the training and the activities contemplated in this agreement.

I voluntarily and freely choose to incur and assume any and all such risks and therefore release INGENIERIA TRANSFORMACIONAL from any harm or injury I may suffer during and as a result of my participation in the training.

2. I expressly release INGENIERIA TRANSFORMACIONAL and the training participants from all liability for any and all claims, actions, or proceedings of any kind that are based on my participation in this training and that may be initiated by me and by any other person or organization on my behalf, and I commit to indemnify and reimburse them for all reasonable legal costs and attorney fees incurred by INGENIERIA TRANSFORMACIONAL or other parties to be indemnified for the defense of any such actions arising directly or indirectly from my participation in this training.

3. I acknowledge that this document is a contract by which I agree to release INGENIERIA TRANSFORMACIONAL (including its employees, shareholders, agents, directors, representatives, and collaborators) from any and all claims on any basis in law or equity that I might have in my favor for any harm or injury I may suffer as a consequence of my participation in the training and its related activities. I likewise waive any compensation to which I might be entitled for any negligent action of INGENIERIA TRANSFORMACIONAL, its employees, shareholders, agents, directors, representatives, and collaborators, and the aforementioned parties.

4. I acknowledge that this contract shall be governed by the laws of the State of Utah and can only be modified by a written agreement signed by the parties.

Having carefully read this contract, I certify that I am of legal age, understand its content, and voluntarily sign it today.

Sign *

Clear Signature

Today's date *

Basic Leadership Training – Questionaire Form

Emergency Contact

Release of Liability

Section I: Consent to Participate

Section II Agreement Releasing Ingeniería Transformacional from Liability.

Agreement on Property Rights Agreement on the ownership of materials, concepts, and information

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