Journey Registration Form
Payment Plan Version

Personal Information

First name

Last name

Nickname

Preferred Name for Your Nametag

Email*

Phone number

Mobile phone number

Preferred Contact Method

What Journey Are You Attending?*

Small Group Preference

In order to attend The Journey Continues co-ed group, you must have participated in an OHM-led The Journey Begins (either at a Regional Journey or at Maranatha). NOTE: All female groups may have co-ed leadership even though all group participants are female.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone #

Street address

City

State/Region

Postal Code

Country/Region

Additional Demographics

Gender

Date of birth

Marital Status

Do You Have Any Children?

How Many Children?

Job Title

Company name

Church Affiliation

Are you attending with someone you know?

Friend, family or church member - if yes, share their name(s) here

Would you like your own room?

Single rooms are very limited and cost $150 extra. Checking yes here does not reserve this option. If no, do you have a roommate preference? Share their name here.

Dietary restrictions

These options are primarily for diagnosed allergies, but may include preference. If you would like to communicate with the location of the event, you may ask your questions directly to them.

Journey Group History

What is your Journey Group history?

Click any that apply.

Never participated

Local Journey at Home

OHM-led Journey at Maranatha

OHM-led Regional Journey

Journey Group Leader Status

If applicable.

Currently Leading Groups

Leading Future Groups

Inactive But Willing to Be a Resource

Inactive

Where Have You Been Cared For?

If you are currently under the care of a psychiatrist/therapist, we must have a recommendation from her/him for you to participate in the seminar. Once you have completed this registration form and purchased your ticket, you will be redirected to the home page of Your Journey Checklist. You may download the form there, have it signed, and upload it on the site, email to darin@ohmin.org, or text pic to 269.389.9491.

When and where did you seek help?

Have you received counseling?

Under Current Care?

Dissociative Diagnosis?

Satanic Ritual Abuse?

What are your expectations for this seminar?

Are there life circumstances that could interfere with your Journey participation?

The Journey can be very intense physically and emotionally. If there are any circumstances in your life (i.e. recent death of a loved one, medical condition, etc…) that could interfere with our ability to participate in The Journey, please write about your circumstances in the space provided.

Waiver of Liability and Participation Agreement

In consideration of my electing to participate in this Open Hearts Ministry event, I agree for myself, my heirs and executors, successors and assigns hereby completely and unconditionally release and agree to defend, indemnify and hold harmless Open Hearts Ministry, Inc., its board members, officers, executive team members, leaders, presenters, employees and other representatives, from and against any and all claims, costs, causes of action, expenses, judgments, and liabilities of any kind whatsoever resulting from, arising out of or in any way relating to my participation in this Open Hearts Ministry event and any counseling or small group sessions in which I may be involved which use the methods or materials developed by Open Hearts Ministry, as well as my use of any information, methods or materials learned at or obtained through the ministry of Open Hearts Ministry.

Open Hearts Ministry reserves the right, should we believe that a participant’s behavior or actions are damaging or disruptive for the participant, other participants or in violation of event location policies, to remove such participant from the small group, the program and, should we feel it necessary, from the seminar location itself. Expenses incurred by this action will be the responsibility of the participant (hotel, taxi, airfare, etc…). In such case, participant fees are not refunded.

I Agree To The Terms of Participation and Liability

Registered Sex Offender Registry

Are you on the registered sex offender registry?

By answering yes or no and typing your name as an electronic signature, you are agreeing that you have answered this question truthfully. While answering yes will not preclude you from attending The Journey, this disclosure is required by law.

Electronic Signature

Media Release and Cancellation Policy

Photograph

Please upload your picture, for OHM staff use only. This is used to allow the ministry and welcome team to recognize you once on campus (to put a face to the name).

Permission to be photographed

Photos may be published and video may be aired for Open Hearts Ministry to use such items for ministry publications and purposes. I understand that if I indicate that I do NOT give permission for photos or videos of myself to be published, I must sit in the special seating section for those that do not wish to be photographed. Please check one.

Cancellation Policy

Cancellations made 60 days or more in advance of the event start date will receive a refund of all monies paid, less a $50 cancellation fee. Cancellations made 45-60 days in advance of the event start date will receive a refund of all monies paid, less the non-refundable $200 deposit. There are no refunds for cancellations made less than 45 days before the event start date.

Journey Registration FormPayment Plan Version