Mental Health Depression and Anxiety Recovery Program Depression and Anxiety Recovery Program™ Registration FormRanelagh Seventh Day Adventist Church - Health MinistryName *SexMaleFemaleEmail Address *PhoneStreet AddressCityZIP / Postal CodeBirthdateI have internet access at home:YesNoHow did you learn of this program?Social MediaFlyerFriendOtherHighest level of education completed:Grade schoolSome high schoolHigh school graduateTrade schoolSome collegeAssociate degreeBachelor's degreeMaster's degreeDoctoral degreeOccupationReligious PreferenceAre you a member of Ranelagh Seventh Day Adventist Church? *YesNoMedical General InformationHave you previously been diagnosed with any mental disorders? *NoMajor depressionGeneralized anxiety disorderObsessive compulsive disorderBipolar disorderSchizophreniaOther psychological disorderAre you currently being treated by a physician? *YesNoAre you currently seeing a therapist or counselor? *YesNoHave you ever attempted suicide?YesNoAre you considering suicide now?YesNoWhat is the main reason you want to take this course? *To improve my mental healthTo better support a loved oneTo learn more about mental healthOtherConsentPlease read the following statements and check the boxes to agree with the following statements.I recognize this is a mental health education program and is not a therapeutic program and cannot substitute for physicians, professional counselors, or mental health providers.I understand that attending this educational program does not establish a physician-patient or therapist-client relationship and I will not make medication or treatment changes without consulting my healthcare practitioner.The community Depression and Anxiety Recovery Program™ is a unique educational program that teaches the causes of depression and anxiety. I understand that the program staff are providing an educational service only and I do not hold them responsible for my mental health and wellbeing.Emergency ContactIn case of emergency, please provide a person you would like to have contacted:Name *Phone *RelationshipPayment Details and ConfirmationPayment Detail€Credit / Debit Card *GDPR Disclaimer**GDPR Disclaimer for DARP Registration:** In accordance with the General Data Protection Regulation (GDPR), all personal data collected through this registration form will be stored securely and used solely for the purpose of administering and managing the DARP. The data will be retained for a period of one year, after which it will be permanently deleted. By registering, participants consent to the collection, use, and storage of their personal data in compliance with current European data protection laws. The information provided will not be shared with third parties without prior consent.Confirm & Pay