1. Name *

First Name

Last Name

3. I understand that this program includes somatic work, mindfulness, and relational group exercises and that it is a not a substitute for medical, psychological, or psychiatric care. *

I understand

4. Participant responsibility over zoom: I understand that as a participant I am responsible for my own physical, emotional, and mental well-being during and after the sessions, and that if I need additional help, I will reach out to my support team. *

I understand

5. I understand that the sessions will be recorded and that my experience will not be used in any way. (The facilitator will be spotlighted so that the recording will only include her). *

I understand

6. Confidentiality: You are welcome to share about your own experiences outside of this group, but please do not share about anyone else's experiences. *

I understand that this is a confidential space

7. This is a relational experience. If you need to miss a week, please kindly let me know so that I can let the group know at the beginning of class. This helps to breed a sense of trust, and keeps attachment systems feeling more secure. *

Will do!

8. I understand that this is a group experience and that I will be invited to share while keeping in mind that each person needs time to be able to share. If I need additional support, I will reach out for individual support. *

I understand

9. By checking this box, I acknowledge that I have read and understood this disclaimer. *

I have read and understood this disclaimer.