Mindfulness and Resilience Course for Everyone

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During the last month, have you experienced any of the following? *

Please check all that apply.

Considered suicide

Sought Psychiatric help

Had thoughts of death or dying

Had urges to beat, injure, or harm someone

Had urges to smash or break things

Had spells of terror or panic

Does not apply

Informed Consent Agreement *

The Mindfulness Training may include skills in meditation methods as well as gentle stretching (yoga) exercises. I understand that if for any reason I am unable to or think it unwise to engage in these techniques and exercises either during the weekly sessions or at home, I am under no obligation to engage in these techniques nor will I hold the instructors liable for any injury incurred from these exercises. I understand that this is an educational program and does not constitute and is not a substitute for medical diagnosis, advice or treatment. I understand that while this program may have therapeutic benefits, it is not psychotherapy or a substitute for psychotherapy. I agree that if I am in need of psychotherapeutic support or intervention, I will seek it through appropriate channels including, but not limited to, asking for referrals from the program instructors. I agree to assume all risk for any physical, mental, and/or emotional consequences of participating in this process/program. I specifically and expressly agree to hold harmless, indemnify, and release all instructors of this training from any and all liability for the results of the educational training that will be or have been provided. I understand that no guarantee is made as to the outcomes or results of this educational training. I give permission for the instructors to contact any therapist that I have previously named on page one.

I am 18 years of age or older.

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This entry constitutes your digital signature and acceptance of our Mindfulness Training Informed Consent Agreement.

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