MBSR- Registration

MBSR Registration Form
Facilitators: Mihaela Dirlea, MSW, RSW

Cancellation Policy
If you cancel your registration before the Early Bird deadline, you will receive a full refund. If you cancel your registration after the orientation session, you will receive a refund of your registration cost with the exception of a non-refundable fee of $50. If you cancel your registration after the first session, you will receive a refund of half (50%) of your program fee. If you cancel your registration after the second session, you will receive no refund. Please refer to program details 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 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.
* indicates required
Examples: flyers, student paper, website (backtothebreath.ca), friend/family, facebook event, etc.
Please summarize your previous experience with meditation, yoga, and other mindfulness practices
Please explain what would help to create a warm, safe, and comfortable group environment for you.
Email Marketing Powered by Mailchimp