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PSI Youth Classes Registration USA

"*" indicates required fields

1Child Info

2Parent #1 Info

3Parent #2 Info

4Tuition Info

Which course are you registering for?*

PSI Basic for Kids*

Youth Leadership Workshop*

New Student or Basic for Kids Graduate?*

New Student

Returning Student

New Student or YLW Graduate?*

New Student

Returning Student

New Student or Teen Experience Graduate?*

New Student

Returning Student

Teen Experience

Dates: June 24th - 29th, 2024

Prerequisites:
Students must be 13-17 years of age and graduates of the adult PSI Basic Seminar

Tuition:
~~$1,495~~ $1,295 USD

Basic for Kids Parent Agreements*

Parents are required to attend the mandatory parent orientation prior to the class. The orientation is typically held the Friday evening prior to the class opening.

Parents are also required to attend the culmination/graduation on Sunday of the class.

I agree to the Basic for Kids Parent Agreements

Youth Leadership Workshop Parent Agreements*

Parents are required to attend the mandatory parent orientation prior to the class. The orientation is typically held the Friday evening prior to the class opening.

Parents will have an exercise to complete with their child(ren) on Saturday afternoon of the class (typically around 3:00pm)

Parents are also required to attend the culmination/graduation on Sunday evening of the class.

I agree to the Youth Leadership Workshop Parent Agreements

Child Information

Child's Name*

First Last

Child's Preferred Name (Nickname)

Child's Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Child's Date of Birth*

YYYY

Child's Age*

Child's Age on Opening Day of Teen Experience*

Where did the child attend the PSI Basic Seminar?*

Date Attended PSI Basic*

YYYY

Child's Gender*

Preferred Gender Pronouns*

Specify Pronouns*

Does Your Child Have Any Food Allergies?*

Yes

Specify Food Allergies

Age & Gender of other Children in Family

Child's School*

Child's Grade*

Do you feel that your child has any particular problems at the present time?

Names & Phone Numbers of persons to be called if parents cannot be reached*

Parent #1 Information

Parent #1 Name*

First Last

Parent #1 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent #1 Email*

Enter Email Confirm Email

Parent #1 Phone*

Parent #1 Best Way to Contact:*

Phone

Text Message

Other

Parent #1 Other Way to Contact

Parent #1 consent to receive communications from PSI Seminars:*

May include phone, email, or social media.

Yes

Parent #1 Marital Status*

Parent #1 Occupation*

Parent #1 Employer*

Parent #1 Level of Education*

Parent #1 Location Attended Basic*

Parent #1 Date Attended Basic*

MM slash DD slash YYYY

Parent #1 Advanced Courses Attended

Select all of the classes you have attended

Life Success Course (PSI 7)

Leadership Seminar

Principia/Summit/Next 10

Pacesetter’s Leadership Dynamics (PLD)

Does child reside with Parent #1 at least 50% of the time?*

Yes

Does Parent #1 have legal custody of the child?*

Sole Legal Custody

Joint Legal Custody

Other

Parent #2 Information

Check this box to skip Parent #2 info section

I am a single parent with sole custody

Parent #2 Name*

First Last

Parent #2 Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent #2 Email*

Enter Email Confirm Email

Parent #2 Phone*

Parent #2 Best Way to Contact:*

Phone

Text Message

Other

Parent #2 Other Way to Contact

Parent #2 consent to receive communications from PSI Seminars:*

May include phone, email, or social media.

Yes

Parent #2 Marital Status*

Parent #2 Occupation*

Parent #2 Employer*

Parent #2 Level of Education*

Parent #2 Location Attended Basic*

Parent #2 Date Attended Basic*

MM slash DD slash YYYY

Parent #2 Advanced Courses Attended

Select all of the classes you have attended

Life Success Course (PSI 7)

Leadership Seminar

Principia/Summit/Next 10

Pacesetter’s Leadership Dynamics (PLD)

Does child reside with Parent #2 at least 50% of the time?*

Yes

Does Parent #2 have legal custody of the child?*

Sole Legal Custody

Joint Legal Custody

Other

Confidential Health Questionnaire

Does your child have any history of psychiatric or behavior problems?*

Yes

Has your child been institutionalized for mental illness within the last twelve months?*

Yes

Has your child undergone treatment by a psychiatrist or psychologist in the last 6 months?*

Yes

Does your child take medication?*

Yes

Please explain any of the above marked "yes"*

PSI Youth Classes are based on an educational model, not a medical model. If your child has any history of psychiatric disorder, or has been institutionalized for mental illness within the last twelve months, or has been undergoing treatment by a psychiatrist or psychologist within the last six months, it is the policy of PSI Seminars that your child does NOT attend at this time.

PSI Youth Classes Terms and Conditions

TERMS AND CONDITIONS (BFK)*

For a child to participate in the Basic for Kids, both parents must be PSI Basic Seminar graduates. In addition, both parents must attend the Parent Orientation Meeting and sign the parental release form prior to the seminar.

Class size is limited, and payment in full does not guarantee a seat in the class. If the class is at capacity your child will be placed on a waitlist. Once registration is complete a representative will contact you to confirm your status.

PSI Seminars are based on an educational model, not a medical model. If your child has any history of psychiatric disorder, or has been institutionalized for mental illness within the last twelve months, or has been undergoing treatment by a psychiatrist or psychologist within the last six months, it is the policy of PSI Seminars that they NOT attend the class.

I have read, understand, and agree to the Terms and Conditions.

TERMS AND CONDITIONS (TE)*

For a child to participate in Teen Experience, they must be 13-17 years of age on the opening day of the class and be a graduate of the adult PSI Basic Seminar.

Class size is limited, and payment in full does not guarantee a seat in the class. If the class is at capacity your child will be placed on a waitlist. Once registration is complete a representative will contact you to confirm your status.

PSI Seminars are based on an educational model, not a medical model. If your child has any history of psychiatric disorder, or has been institutionalized for mental illness within the last twelve months, or has been undergoing treatment by a psychiatrist or psychologist within the last six months, it is the policy of PSI Seminars that they NOT attend the class.

I have read, understand, and agree to the Terms and Conditions.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19*

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact.

PSI WORLD, AND PSI SEMINARS, LLC strongly recommends vaccination prior to attending any seminars and/or indoor gathering.

PSI WORLD, AND PSI SEMINARS, LLC has put in place preventative measures to reduce the spread of COVID-19; however, PSI World and PSI Seminars cannot guarantee that you will not become infected with COVID-19. Further, attending our seminar could increase your risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending a PSI Seminar’s event and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the seminar may result from the actions, omissions, or negligence of myself and others, including, but not limited to, PSI employees or staff, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at, or participation in PSI Seminars (‘Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless PSI, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of PSI World or PSI Seminars, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any PSI Seminars program.

I have read, understand, and agree to the Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

PSI ADVANCED SEMINAR TUITION POLICY*

I understand that payment for any PSI Advanced Course is non-refundable/non-transferable. All monies held must be utilized within 6 months from the date of the initial payment or it is forfeited. If I choose to attend a date other than the seminar I am registered for and have not notified the Main Office in writing prior to 30 days before the start of the seminar, I understand that I am subject to an administrative fee of $1000.

Class size is limited, and payment in full does not guarantee a seat in the class. If the class is at capacity you will be placed on a waitlist. Once your registration is complete a representative will contact you to confirm your status.

I have read, understand, and agree to the Terms and Conditions.

ARBITRATION CLAUSE*

If a dispute arises out of or relates to this contract, or the breach thereof, and if said dispute cannot be settled through direct discussion, the parties agree at first endeavor to settle the dispute in an amicable manner by mediation administered by the American Arbitration Association under its Commercial Mediation Rules, before resorting to arbitration. Thereafter, any unresolved controversy or claim arising out of or relating to this contract, or breach thereof, shall be settled by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules, and judgement upon the reward rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.

I have read, understand, and agree to the Arbitration Clause.

HAWAII WAIVER*

The law in Hawaii is drafted to protect those who deposit money to attend a sensitivity awareness group seminar by granting the student the right to cancel the course before the first day of the course and obtain a refund of sums paid less $50. We have the obligation to disclose this right to you.

However, PSI Seminars limits its enrollment positions for the class. Once the class is full, expenses for providing the course become part of the overall budget for the presentation of the class, including but not limited to, transportation and lodging of the students, food preparation and presentation, materials, supplies, and all other related costs which are fixed. Unfortunately, if any student should request and demand a refund, the financial domino effect upon those who do attend will be felt. The costs of the course are kept at a minimum to make it accessible to as many as possible.

In order to be fair, PSI Seminars requests those who are residents of Hawaii to waive the protections otherwise provided under law, and accept that the commitment to attend the seminar will be relied upon by others financially, and that the enrollment fee is part of the fixed cost of presenting the seminar for all members. By registering below the student waives the refund rights accorded by the laws of the State of Hawaii.

I waive my entitlement to a refund under Hawaii law.

Parent #1 Signature*

I have answered all questions truthfully, and I have read, understand and agree to all policies and clauses contained within.

Parent #2 Signature*

I have answered all questions truthfully, and I have read, understand and agree to all policies and clauses contained within.

Payment Details

Teen Experience*

Teen Experience 2024

PSI Basic for Kids USA - New Student

Price:

PSI Basic for Kids USA - Returning Student

Price:

Youth Leadership Workshop - New Student

Price:

Youth Leadership Workshop - Returning Student

Price:

Registration Code

Be sure to click "Apply" after entering your code!

Total

Credit Card*

Card Details

Cardholder Name

Payment Status: {entry:payment_status} ${entry:payment_amount} {entry:currency} 12/21/2024
Coupon: {Coupon:28}
Transaction ID: {entry:transaction_id} | {Credit Card (Card Type):8.4} {Credit Card (Card Number):8.1} {Cardholder Name:71}

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PSI Youth Classes provide an environment of love and support, where kids reaffirm that it’s okay to be themselves, and that they are valuable and deserving just the way they are.

Basic for Kids is a two-day course for kids ages 5 to 12.
Youth Leadership is a two-day workshop for youth ages 8 to 14 who have completed either the Basic for Kids or the adult PSI Basic Seminar.
Teen Experience is for graduates of the adult PSI Basic Seminar ages 13 to 17.

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Register

PSI Youth Classes Registration USA

Child Information

Parent #1 Information

Parent #2 Information

Confidential Health Questionnaire

PSI Youth Classes Terms and Conditions

Payment Details

Privacy

Security

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