Character(s) Fear Therapy at Ghostwood Manor, Patients and Residents

[YellowMelon]

APPLICATION FORM FOR FEAR THERAPY AT GHOSTWOOD MANOR Who is filling out the application? ☐ Family member ☐ Friend ☐ Myself​

Consent Agreement

I have read and understood the information provided on the website, releaseyourfears.com

I have had opportunities to ask questions about Ghostwood Manor and the fear therapy offered. All of my questions have been answered to my satisfaction.

I understand that all the information I provide in this application and during therapy sessions can be used in my treatment, and, as such, is not confidential.

By signing, I have agreed to undergo fear therapy at Ghostwood Manor and accept any risks involved in participation, accept all liability, and will hold Ghostwood Manor harmless for any damages or injuries, both emotional and physical, possible incurred through therapy sessions

Note: Ghostwood Manor does not seek to harm their applicants, but when dealing with irrational and extreme fears harm may be unintentionally caused to the application by the applicant themselves or other participants.

Electronic Signature:

Applicant Information ​ Height: Hair Color: Eye Color: If you have tattoos, where are they located? If you have piercings, where are they located? Do you have any scars and/or birthmarks? Name: (first middle last) Age: Gender: Sexuality: Profession: Is your job full time or part-time?

Fear Therapy Please list your fears and explain why they frighten you. Have you had therapy before to address these fears or have you tried to overcome them on your own? If so, explain. If accepted, what do you hope to achieve through fear therapy? Do you have a preference for one-on-one sessions or group sessions? If no preference, write none. ​

Medical Details Please list any medical conditions that you have (for example, asthma, bone/joint problems, asthma attacks, diabetes, sleep apnea, heart problems, etc.) How often do you use the following? Drugs Alcohol Cigarettes/Vape​ Have you had any past surgeries and/or hospitalizations? yes/no If yes, please list the surgery/hospitalization and explain any complications. Do you take any medications? yes/no If yes, please list them and the reason you are taking them: Do you have any allergies? yes/no If yes, please list:

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releaseyourfears.com | Contact Us

 

[YellowMelon]

Who is filling out the application? ☐ Family member ☐ Friend 🗹 Myself​

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⠀ Slow - Diviners ft. Reill (representative of Anastasia's voice)

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⠀⠀⠀living with an overprotective brother . . . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ——⠀ANASTASIA MARIE NICHOLSON ⠀——​ 𝓐pplicant Information NICKNAMES AGE GENDER SEXUALITY PROFESSION CAREER ASPIRATION Annie/Nichole/Nikki 23 female heterosexual full-time unemployment author ​ 𝓕ear Therapy Questionnaire Please list your fears and explain why they frighten you. spiders, centipedes, millipedes - the more legs an insect has the faster they're able to run which is terrifying syringes with needles - trauma from wisdom tooth removal where she was given local anesthesia (lidocaine) dying alone and not being found after death - afraid that her body would be forgotten about being kidnapped - her mind wanders about what physical torture she may suffer if she was kidnapped​ Have you had therapy before to address these fears or have you tried to overcome then on your own? If so, explain. No, Annie has always sought comfort from her brother when scared of anything​ If accepted, what do you hope to achieve through fear therapy? New friends. Annie is neutral toward the thought of undergoing fear therapy and really signed up because she thought it would a fun and exciting experience. She hopes to meet and become friends with other participants, whether the therapy sessions work for her or not.​ Do you have a preference for one-on-one sessions or group sessions? If no preference, write none. Group sessions.​ 𝓜edical History Medical Conditions​ severe winter depression​ Substance Use​ uses and shares vapes at parties, consumes alcohol at same parties, attends parties at least once a month​ Surgeries/Hospitalizations wisdom teeth removal (age 18), admitted to ER for an infection Medications combination birth control Allergies strawberries, pineapple, kiwi → anaphylaxis if consumed in large amounts; sensitive to certain perfumes and deodorants → skin reaction 𝓒onsent Agreement I have read and understood the information provided on the website, releaseyourfears.com I have had opportunities to ask questions about Ghostwood Manor and the fear therapy offered. All of my questions have been answered to my satisfaction. I understand that all the information I provide in this application and during therapy sessions can be used in my treatment, and, as such, is not confidential. By signing, I have agreed to undergo fear therapy at Ghostwood Manor and accept any risks involved in participation, accept all liability, and will hold Ghostwood Manor harmless for any damages or injuries, both emotional and physical, possible incurred through therapy sessions Note: Ghostwood Manor does not seek to harm their applicants, but when dealing with irrational and extreme fears harm may be unintentionally caused to the application by the applicant themselves or other participants. Electronic Signature: 𝒜𝓃𝒶𝓈𝓉𝒶𝓈𝒾𝒶 𝑀𝒶𝓇𝒾𝑒 𝒩𝒾𝒸𝒽𝑜𝓁𝓈𝑜𝓃​ Height: 5'6" Hair Color: dark brown Eye Color: blue eyes If you have tattoos, where are they located? left collarbone, right ankle If you have piercings, where are they located? upper ear piercings, middle tongue piercing Do you have any scars and/or birthmarks? no Tattoos left collarbone right ankle

 

[YellowMelon]

Who is filling out the application? 🗹 Family member ☐ Friend ☐ Myself​

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⠀ Don't Miss You At All - FINNEAS (deeper parts representative of Alexander's voice)

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⠀⠀⠀caring for a spoiled sister . . . ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ——⠀ALEXANDER JAMES NICHOLSON⠀——​ 𝓐pplicant Information NICKNAMES AGE GENDER SEXUALITY PROFESSION CAREER ASPIRATION Alex 26 male bisexual leaning gay freelance graphic designer, flexible hours graphic design and photography​ 𝓕ear Therapy Please list your fears and explain why they frighten you. Abandonment in a relationship - stems from a 4-year emotionally abusive relationship with an ex-boyfriend. Being in complete darkness/blindfolded/loss of vision - afraid of not being able to react fast enough if something were to happen in the dark Deep bodies of murky water - doesn't like not knowing what could be swimming under him, especially if it's a predatory animal​ ​ Have you had therapy before to address these fears or have you tried to overcome them on your own? If so, explain​ In a past relationship, Alex did attend couples therapy, which eventually became one-on-one therapy, to try to fix the relationship. After the break-up, he continued to seek counselling, but eventually dropped it because he didn't feel like he was being listened to.​ If accepted, what do you hope to achieve through fear therapy?​ Honestly, Alex just let his sister sign him up for fear therapy because she was talking about it non-stop and said she needed him to be there for emotional support. Having gone to therapy before, he doesn't really like having to open up to a stranger about his weaknesses. If fear therapy were to work, he'd like to be able to overcome his fear of the dark because that is the reason for his insomnia.​ Do you have a preference for one-on-one sessions or group sessions? If no preference, write none. None​ ​ 𝓜edical History Medical Conditions​ chronic insomnia, subclinical depression​ Substance Use​ alcohol, drinks spiked lemonade on Fridays​ Surgeries/Hospitalizations wisdom teeth removal (age 18), no complications​ Medications prescribed antidepressants for insomnia, does not take​ Allergies mangoes and dried fruit - inside of mouth will become itchy and break out in hives, lips will become swollen​ 𝓒onsent Agreement I have read and understood the information provided on the website, releaseyourfears.com I have had opportunities to ask questions about Ghostwood Manor and the fear therapy offered. All of my questions have been answered to my satisfaction. I understand that all the information I provide in this application and during therapy sessions can be used in my treatment, and, as such, is not confidential. By signing, I have agreed to undergo fear therapy at Ghostwood Manor and accept any risks involved in participation, accept all liability, and will hold Ghostwood Manor harmless for any damages or injuries, both emotional and physical, possible incurred through therapy sessions Note: Ghostwood Manor does not seek to harm their applicants, but when dealing with irrational and extreme fears harm may be unintentionally caused to the application by the applicant themselves or other participants. Electronic Signature: 𝒜𝓁𝑒𝓍𝒶𝓃𝒹𝑒𝓇 𝒥𝒶𝓂𝑒𝓈 𝒩𝒾𝒸𝒽𝑜𝓁𝓈𝑜𝓃​ Height: 6'3" Hair Color: dark brown Eye Color: light brown If you have tattoos, where are they located? right and left arms If you have piercings, where are they located? no Do you have any scars and/or birthmarks? no Tattoos left arm right forearm right upperarm

 

[Toffive]

Who is filling out the application? 🗹[Family member ☐ Friend ☐ Myself

full character name — Five Mac Blind — Five, Fire starter — ALIASES — Man — GENDER — 25 — AGE — — — Bisexual, man leaning — ORIENTATION — ​

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⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀ BASICS Write a small intro for your character. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Duis sollicitudin elit sed tellus blandit viverra sed eget odio. Donec accumsan tempor lacus, et venenatis elit feugiat non. Duis porta eros et velit blandit dapibus. Curabitur ac finibus eros. Duis placerat velit vitae massa sodales, eget mattis nibh pellentesque. Duis sollicitudin elit sed tellus blandit viverra sed eget odio. Donec accumsan tempor lacus, et venenatis elit feugiat non. ⠀⠀ LOOKS Short description of typical outfit, accessories, or distinguishing marks. Basic appearance information and face claims/art/aesthetic pictures will be placed under the accordion. Duis sollicitudin elit sed tellus blandit viverra sed eget odio. Donec accumsan tempor lacus, et venenatis elit feugiat non. Duis porta eros et velit blandit dapibus. Curabitur ac finibus eros. Duis placerat velit vitae massa sodales, eget mattis nibh pellentesque. Duis sollicitudin elit sed tellus blandit viverra sed eget odio. ​ Tab 1 Profession: Unemployed Is your job full time or part-time? None If so, where?Oop ⠀⠀ TRIVIA ⥼ Put some character facts or mannerisms here. ⥼ Lorem ipsum dolor sit amet, consectetur adipiscing elit. ⥼ Duis sollicitudin elit sed tellus blandit viverra sed eget odio. ⥼ Donec accumsan tempor lacus, et venenatis elit feugiat non. Duis porta eros et velit blandit dapibus. ⥼ Duis placerat velit vitae massa sodales, eget mattis nibh pellentesque. ​ Tab 1 Please list your fears and explain why they frighten you. Being burned alive( Main) Spiders Closed spaces Heights Injections Have you had therapy before to address these fears or have you tried to overcome them on your own? If so, explain. If accepted, what do you hope to achieve through fear therapy? Hopefully my money back. But if this does work, which Five doubts highly--he'll expect progress and character improvement, maybe be a better person to his mom--rather then blame her. Do you have a preference for one-on-sessions or group sessions? If no preference, write none. None 𝓜edical History Medical Conditions Bi-polar depression, Depression, Substance Use alcohol, weed almost 24/7, pain meds Surgeries/Hospitalizations Alcohol poison (18) Overdose(19)broken arm(19) Medications prescribed Iithium and ketamine, overly takes them. Allergies Certain pain meds. 𝓒onsent Agreement I have read and understood the information provided on the website, releaseyourfears.com I have had opportunities to ask questions about Ghostwood Manor and the fear therapy offered. All of my questions have been answered to my satisfaction. I understand that all the information I provide in this application and during therapy sessions can be used in my treatment, and, as such, is not confidential. By signing, I have agreed to undergo fear therapy at Ghostwood Manor and accept any risks involved in participation, accept all liability, and will hold Ghostwood Manor harmless for any damages or injuries, both emotional and physical, possible incurred through therapy sessions Note: Ghostwood Manor does not seek to harm their applicants, but when dealing with irrational and extreme fears harm may be unintentionally caused to the application by the applicant themselves or other participants. Electronic Signature: Five Mac Blind ​ ​ ​ ❝ I don't want to be here....so what you're saying is you don't love me for me and all my flaws!! Fuck you mom, you should have gone to the clinic to save yourself the trouble!❞​