Registration Form

Mindful Self-Compassion Program : July 31–Sept 18, 2017

Please fill out the application form below. This confidential information will only be used to ensure you can realise the full benefits from your participation in the training. If you feel uncomfortable answering any questions, please note that on the form and you can discuss this privately before the program begins.

Are you currently seeing a therapist or counselor?

Is your counselor aware you are attending this retreat?

Have you been diagnosed with a serious mental health illness?

I understand that my participation in this program is entirely voluntary and I am free to withdraw at any time and I understand that the course fee is not refundable. At the present time, I am planning to participate in the entire course (including the 4 hour retreat) and to practice mindful self-compassion for approximately 30 minutes a day (formally and informally). I also understand that I am responsible for my personal safety and well being and will practice self-care throughout the program.

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