First Name *

Last Name *

I commit to participating in all the sessions each week, and to treat myself, my facilitator, and my group with kindness. The instructor, at his/her discretion, may remove or bar participants whose behavior—before, during, or after an offering is deemed inappropriate and/or disruptive. *

Limits of Confidentiality: What you discuss during your meditation session is kept confidential. No contents of the sessions, whether verbal or written may be shared with another party without your written consent or the written consent of your legal guardian. *

Audio/ Video Recordings: Meditation classes may involve the audio or video recording of the class for instructor feedback and quality purposes. Neither your name nor any other identifying information will be associated with the recording, and/or the transcript. Only the meditation teacher will be able to listen/view the recordings. By signing this form, I am allowing the meditation teacher to audio/video record me as part of this meditation class. *

Liability Waiver: I hereby agree to the following: 1. I am participating in classes or services during which I will receive information and instruction about meditation. I recognize that I may also choose to do physical movement, such as yoga, sitting, standing and walking meditation. I represent and warrant that I have no physical or mental health condition that would prevent my safe participation in meditation classes. 2. In consideration of being permitted to participate in the meditation classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I might incur as a result of participating in the program and I knowingly, voluntarily, and expressly waive any claim I may have for injuries or damages that I may sustain as a result of participating in classes or workshops. *