Glastonbury Therapists Forum

Glastonbury Pilgrim Reception Centre PART A Glastonbury Therapists’ Forum Application Application Form for Membership Please note that this is a Forum for Therapists in Glastonbury (and immediate surrounding areas) only

THIS FORM TO BE USED FOR RETURN BY EMAIL WITH ONLINE PAYMENT VIA PAYPAL ONLY. YOU DO NOT NEED A PAYPAL ACCOUNT IN ORDER TO MAKE A PAYMENT – ONLY A CREDIT/DEBIT CARD. If you wish to join in person, please download the form on the ‘Joining in person’ link on our website.

To see examples of other therapist’s entries, please visit www.glastonbury-pilgrim.co.uk and look under our therapies and healing section

Please also note that we ask all our TF members to agree and sign the Therapists’ Forum Code of Ethics. [PART C]

Name (Including if applicable, abbreviations re. professional accreditation/qualifications e.g. Joe Bloggs MA, UKCP Reg.):

Practice Name (if applicable) and Address:

Telephone: Email:

Website:

Please HIGHLIGHT IN RED which listing you would like:

CHOICE 1: CHOICE 2: Basic- £12.00 per annum. Enhanced - £12.00 per annum (pro rata) to join the Therapists’ Forum payable to (TWO therapies with all the above information plus TEN Glaston Centre Ltd PLUS £60.00 (pro rata) per annum (Payable to Glastonbury Online*) words of description) An enhanced listing gives you the options to go under SIX therapies & include a longer Renewable once a year on April 1st. If you are joining after April, you will be charged pro rata as follows: description about your work PLUS a colour logo. See www.glastonbury.co.uk for examples. If you choose this option, please also list all the therapy headings you have chosen below. (Please HIGHLIGHT IN RED which applies to you): April £12 May £11 June £10 July £9 *Send only pro rata Therapists’ Forum fee i.e. £12, for now Aug £8 Sept £7 Oct £6 Nov £5 Hazel from GOL will contact you about the next step. Dec £4 Jan £3 Feb £2 Mar £1

Your Therapies

Glastonbury Therapists’ Forum, Glastonbury Pilgrim Reception Centre and Glastonbury Online in no way endorse your practice, however, we do ask members of the Forum to be transparent about their qualifications and/or experience and training.

(SEE PART B FOR HEADINGS & SUB-HEADINGS) Qualifications and/or Experience/ Training Fee: Therapy – include the main heading & therapy sub-heading that you would like to be listed under on the website. e.g. Main heading: Massage. Therapy Sub-Heading: Aromatherapy

Main heading Fee 1st listing

Therapy sub-heading

Main heading 2nd listing

Therapy sub-heading If you have also chosen a ‘ Glastonbury Online’ enhanced listing use the space below to continue adding other therapies practised.

Main heading 3rd listing Therapy sub-heading

Main heading 4th listing

Therapy sub-heading

5th listing Main heading

Therapy sub-heading

6th listing Main heading

Therapy sub-heading

TEN WORDS OF DESCRIPTION If you have chosen the basic listing you get ten words of description. This could include how many years you have been in practice, accreditation, other therapies practised, more info about the therapy e.g. if under sub-heading ‘Psychotherapy’ this is where you would put what model you use: i.e. Humanistic, Gestalt, Core process etc. Please write your ten words below. Check out under our therapies and healing section on our website at www.glastonbury-pilgrim.co.uk for examples if you need some inspiration!

If you do not have a website, are you considering one? Highlight in red Yes / No / Maybe

Would you like Glastonbury Online to contact you Highlight in red to discuss your needs regarding a website? (£120 a year and also Yes / No includes enhanced listing in the therapists section on GOL)

I give permission for my details to be held on the GOL & Glastonbury Therapists’ Forum database and understand that my personal details will be available to the general public on the GOL website, & for client referral purposes but otherwise will not be passed on to any third parties.

I will notify you if these details change within my membership year.

WRITE IN THE BOX BELOW THE DATE YOU MADE YOUR PAYMENT ONLINE VIA PAYPAL I HAVE MADE MY PAYMENT VIA PAYPAL ON (DATE)

I understand that membership to the Glastonbury Therapists’ Forum in no way acts as an endorsement or recommendation to the general public and that the information regarding my experience, training and qualifications as outlined above is true and accurate.

I ALSO AGREE TO ABIDE WITH AND HAVE SIGNED THE GLASTONBURY THERAPISTS’S FORUM CODE OF ETHICS.

Name: Date: Therapy / Healing Categories PLEASE NOTE THAT THIS IS FOR YOUR REFERENCE ONLY TO SEE THE CATEGORIES. PART B INSERT YOUR CHOICE/S UNDER ‘YOUR THERAPIES’ ON PAGE 1 OF PART A. Categories

The main headings of therapies offered are: - Complementary Medicine, Counselling / Therapy, Massage, Bodywork, Movement / Sound, Bodywork, Healing, Readings

Each main heading leads to a sub heading under which therapists are listed. If you have opted for the basic Forum Membership you are allowed entry under two headings. (With the enhanced listing you can go under up to six headings). Have a look on Glastonbury Online to see how this works. On the website you will only see a sub-heading if we have a therapist listed, so see below for the full list. If you have a therapy that is not listed here and can make a really good case for a separate sub-heading please contact us so that we can include your therapy in the listing

Main Heading Therapies Main Heading Therapies leading to -> leading to -> Complementary Allergy Testing Counselling / Counselling medicine -> Acupuncture Therapy -> Drama Therapy Ayurvedic Medicine EFT Chinese Medicine Family Therapy Herbal Medicine Hypnotherapy Homeopathy/Flower Essences Life Coaching Kinesiology NLP Naturopathy Past Life Regression Nutritional Therapy Psychotherapy Iridology Play Therapy Trauma Therapy Stress Management

Massage -> Massage Bodywork -> Alexander Technique Aromatherapy Body Harmony Indian Head Massage Bowen Technique Lymphatic Drainage Colonic Hydrotherapy Reflexology Craniosacral Therapy Metamorphic Chiropractic Sports /Remedial Osteopathy Other Shiatsu Tibetan Pulsing Other

Movement/Sound- Biodanza Healing -> Animal Healing > Music Therapy Chakra Balancing Sound Healing Colour Healing/Aura Soma T’ai Chi Core Energy Management Voice Work Crystal Healing Yoga Therapy Geomancy/ Space healing/ Feng Shui Other Reiki Shamanic Healing Spiritual Healing Other

Readings -> Astrological Numerology Palmistry Psychic Readings Tarot Runes Other PART C Glastonbury Therapists Forum – Code of Ethics Code of Ethics

We ask all our practitioner members to agree to abide by this Code of Ethics. This is an informal agreement based on trust and goodwill. As we are not an association with a formal complaints procedure - should we hear of any practitioner breaking the code of ethics, this will be dealt with informally. Any client wishing to make a formal complaint would have to go through the relevant practitioner’s association and not the Forum. Having said this, we do reserve the right to ask practitioners to relinquish their membership in the unlikely event whereby they are no longer abiding by the agreements that they have signed up to.

PLEASE READ THROUGH AND ‘SIGN’ AT THE BOTTOM

1. Good Relationships with Clients  That I will treat every client politely and considerately.

 I will make sure that my personal beliefs do not prejudice my interactions with my clients – I will not allow my views about a client’s lifestyle, culture, belief, race, colour, gender, sexuality, age, social status or perceived economic worth to prejudice the work that I perform or recommend.

 I agree to adequately assess my client’s needs. I will Listen to and respect their views, and allow them to be fully involved in decisions about my work for them.

 I will recommend and perform only the treatment or services that serve my client’s needs.

 I will explain my services to my clients in a way that they can understand, and be satisfied that the client understands and agrees to what is proposed before I begin.

 I respect the right of my clients to decline my services after these have been outlined and explained.

 I will recommend and advise additional or otherwise relevant services or actions when necessary, including referring to another practitioner or other professional.

2. Maintaining Trust with Clients and The Public  I will always behave in an honest and trust-worthy manner with my clients and with the public.

 I respect my client’s dignity and privacy, and will not reveal my client’s identity without prior permission.

 I will never improperly disclose or misuse confidential information that I may discover or become privileged to in the course of my work.

 I agree to not use my position to establish improper personal relationships with clients or their close relatives.

 I agree that I will not deliberately withhold relevant or appropriate information or services from my clients.

3. Respecting Relationships with Colleagues  I agree to always treat my colleagues fairly, be willing to consult with them and must be prepared to justify my actions to them if necessary.  I will never discriminate unfairly against my colleagues, or allow my views of their lifestyle, culture, belief, race, colour, gender, sexuality, age or social status to prejudice my professional relationship with them.

 I will not make any client doubt a colleague’s knowledge or skills by making unnecessary or unsustainable comments about them.

4. Good Performance  I will strongly endeavour to keep my knowledge and skills up to date.

 I will keep clear and accurate records of relevant findings and work conducted.

 I agree to recognise (and work within) the limits of my competence.

5. Providing Information About Your Services  When discussing or publicising my work, I will be responsible and considerate of the effects that such information may have both on any individuals concerned and on public opinion generally. I will avoid sensational or misleading statements and bear in mind the likely accuracy and completeness of the information.

 If I publish or broadcast information about my services, the information will be factual and verifiable. The information that I publish will not make claims about the comparative quality of my services nor compare my services with those my colleagues provide. If my work includes healing or therapies of any kind I agree that I will not in any way, offer guarantees of cures, nor exploit a client’s vulnerability or lack of knowledge.

 Information that I publish or provide about my services will not put pressure on people to use a service, for example by arousing fear for their present or future health or well-being.

6. Legal Observance & Commercial Dealings  I agree to observe and keep up to date with any laws and statutory codes of practice which affect my work.

 I will give due consideration to obtaining adequate insurance for any part of my work that calls for or allows such cover both to protect myself and my clients.

 I agree to be honest in financial and commercial matters relating to my work.

 I agree to inform clients of my method of charging, estimated fees and all additional costs that may apply before I commence any work for them.

 I agree not to put pressure on my clients to give or lend money or their benefits to myself or other people.

 When taking part in discussions about selling goods or services, I agree I will declare any relevant financial or commercial interest which I or my family might have in the transaction.

PLEASE FILL IN THE BELOW

I, [insert name ] agree to abide by the above.