Expression of Interest for smartEducation for Guidance Teachers Fall 2023 or Winter 2024

SMART Stress Management and Resiliency Techniques

Delivery: LIVE online via ZOOM
(includes participant manual and lifetime access to audio materials)

For more information, please email info@mindfulnesseveryday.org

I am interested in taking a smartEducation course.

I am interested in taking a smartEducation course. 2x Weekly on Tuesdays and Thursdays November 14, 16, 21, 23, 28, 30, Dec 5, 7, 12 | TIME TBD January -March 2024 Dates/Times TBD Future date
Preferred Times

Preferred Times 4:30 pm - 6:30 pm 6:00 pm - 8:00 pm 7:00 pm - 9:00 pm
Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Preferred Phone Preferred Phone * - ### - ### ####
Name of Institution/Organization
What are your preferred pronouns? *

What are your preferred pronouns? he/him she/her they/them other other
Age *

Age 0-25 26-35 36-45 46-55 56-65
Allergies &/or physical requirements
Before teaching mindful movement (which is an integral part of the SMART Program), we want to get to know any physical limitations you might have so we can keep you safe.

Here is a list of common physical limitations. Please check the ones that apply to you. You are not alone.

Before teaching mindful movement (which is an integral part of the SMART Program), we want to get to know any physical limitations you might have so we can keep you safe.

Here is a list of common physical limitations. Please check the ones that apply to you. You are not alone. Lower back pain • Osteoarthritis of the back • Osteoporosis/osteopenia Carpal Tunnel • Arthritis in the wrist/fingers Shoulder/Rotator Cuff injuries • Frozen Shoulder • Bursitis/Tendonitis of Elbows or Shoulders Knee injuries • Arthritis in the knees Glaucoma • Eye infection Pregnancy • Hernia • Abdominal Surgery Prone to headaches • Migraines Dizziness Ankle injury • Arthritis in feet Other Other
Please tell us why you would like to take SMART training. *
Please tell us about any mindfulness/meditation/yoga training you have had, including any retreats that you have attended *
Any other information that you’d like us to know
Mindfulness Everyday Liability Waiver
We are committed to the safety and well-being of our participants at all times. We insist that all participants follow safety instructions designed to protect them. Participants must recognize, however, that the risk of injury still exists. By checking the box below, you hereby agree to assume the full risk of any personal injury, loss or damage to property, regardless of severity, arising from their participation in the program, and agree to waive all related claims against Mindfulness Everyday. *

Mindfulness Everyday Liability Waiver
We are committed to the safety and well-being of our participants at all times. We insist that all participants follow safety instructions designed to protect them. Participants must recognize, however, that the risk of injury still exists. By checking the box below, you hereby agree to assume the full risk of any personal injury, loss or damage to property, regardless of severity, arising from their participation in the program, and agree to waive all related claims against Mindfulness Everyday. I agree
Insurance
MBSR / SMART / MSC is not therapy or medical treatment. However, some insurance plans do cover health education and wellness classes. If your plan covers the SMART program, we will provide the information you need to request reimbursement directly from your insurer.
Payment to be paid only if course is running. Do not send payment at this time. $ Dollars . Cents
If paying by Interac (preferred), please send your payment to payments@mindfulnesseveryday.org
Discount Code
C$0

Total

Expression of Interest for smartEducation for Guidance Teachers Fall 2023 or Winter 2024

Expression of Interest for smartEducation for Guidance Teachers Fall 2023 or Winter 2024

C$0

Total

C$`0`