MB-EAT ON-LINE PROGRAM
RELEASE FORM - WAIVER OF LIABILITY
I understand that MB-EAT is a psychoeducational mindfulness-based skills training program, not group therapy. MB-EAT is designed to teach participants the tools needed to develop and cultivate a mindfulness and weight neutral awareness practice. I understand that MB-EAT does not take the place of personal therapy.
I do not have any physical conditions that might affect my participation. (For this workshop, we will be sitting for approx. 2hrs. However, modifications can be made – we invite you to take care of yourself during the workshop if you need to move/stand.)
I am not experiencing any mental or psychological challenges or acute life event at this time that may prevent me from participating fully and safely in the program.
I understand that while this program may have therapeutic benefits, it is not psychotherapy or personal nutritional counselling nor a substitute for psychotherapy or personal nutritional counselling. The facilitators of this program may be credentialed psychotherapists or nutritionists (e.g., clinical social worker, holistic nutritionist) but their role in this program is strictly as facilitators and teachers and not as psychotherapists or individual nutritionists. Thus, any interactions between myself and the facilitators should not be construed as being psychotherapy or individual nutritional counselling and do not imply a clinical relationship between us. I agree that if I am in need of psychotherapeutic or specific nutritional support or intervention, I will seek it through appropriate channels including, but not limited to, asking for referrals from the program facilitators.
I understand that all transformational programs involve risk. I understand that personal safety and emotional wellbeing are the foundation of MB-EAT training and that I am primarily responsible for my own safety. I will respect my own abilities and limits and ask for support and advice from the instructor(s) if I experience any physical pain or psychological distress. If I have concerns, I will consult a physician before taking the program. I assume responsibility for any injury that may result from my participation.
I understand that the use of an on-line platform for the attendance of this program is due to requirements for physical distancing as per Public Health of Ontario and Canada. I understand and agree to attend this program in this format. Endeavours are made to make use of a platform that will allow for reasonable assurance of confidentiality. I understand that I am to ensure that no one else is listening in to the program as I attend this session. I agree to not tape the session in any format. I also agree not to share the link to the on-line class via social media or with others who are not registered for the program.