MBSR Registration Form
Facilitators: Mihaela Dirlea, MSW, RSW
I understand that this program is not recommended in cases of active suicidal ideation, active psychosis, active substance abuse, severe depression, and severe PTSD.
I understand that in addition to attending the weekly sessions, I will be asked to complete 30-60min of home practice/day.
I understand that if I cancel my registration before the Early Bird deadline, I will receive a full refund. If I cancel my registration after the orientation session, I will receive a refund of my registration cost with the exception of a non-refundable fee of $50. If I cancel my registration after the first session, I will receive a refund of half (50%) of my program fee. If I cancel my registration after the second session, I will receive no refund. Please refer to course schedule for program dates.
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete and that I understand the contraindications, time commitment and cancellation policy written herein. I understand that if I am accepted as a participant into the program, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
NOTE: Please do not share any information on this form that you deem to be sensitive in nature. While all the information you submit will be kept confidential by the facilitators, the online form is not considered to be a secure form of communication. If you need to communicate information of sensitive nature, please contact us by phone at 647 865 8955.
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