Mindfulness-Based Stress Reduction Online Meditation Class

^{Registration Form and Service Contract
_________________________________________________________________________}

 

^{1. SCOPE}

^{I, Dr. Brenda S. Butterfield, have been employed by you to teach a Mindfulness-Based Stress Reduction (MBSR) Meditation course. During the 8-week course, you can expect me to do my best to help and support you develop mindful practices and mindful meditation skills. Although I am a licensed Mental Health Therapist, it is important to clarify that the MBSR Meditation curriculum is an educational course. It is therapeutic but it is not therapy or a support group. It is not the practice of medicine or a substitute for psychotherapy, medical attention, examination, diagnosis, or treatment. The class is not designed to treat any specific condition, but rather to help you develop a different relationship with the stressors in your life.}

^{Although we will be developing relationships by learning and growing together, we will explicitly not be “helping” or advising each other. The focus in the class will be on your health and well-being. You are encouraged to notice what comes up for you with an open, accepting, curious attitude toward oneself and others in the class.}  

^{2. FEE}

^{Tuition of the class is offered on a sliding fee scale based on what you can pay. (Reduced fee $375, Full fee $450, Supporting fee $550). Professionals can earn up to 26 Continuing Education Credits: Please add an additional $75 fee to your tuition if earning CE Credits (social workers, marriage and family therapists, mental health counselors, registered nurses, naturopathic doctors).}

• ^{Reduced fee $375 + $75 CE credits = $450}
• ^{Full fee $450 + $75 CE credits = $525}
• ^{Supporting fee $550 + $75 = $625}

^{Pay online using the Venmo app to send payment set up as bank to bank transfer to avoid credit card processing fees. Dr. Butterfield’s Venmo user name is Brenda-Butterfield (LINK TO VENMO). You can also send payment through Paypal (LINK TO PAYPAL).}

^{When your online form and payment have been received, you will receive an email confirming your place in class.} 

^{3. CANCELLATION}

^{I agree to be available for all 8 scheduled classes and the 6-hour retreat. If for any reason I cannot attend class I will notify you via phone or email as soon as possible. To cover all material in the MBSR Meditation curriculum, I will extend the class to ensure 8 classes and a 6-hour retreat is provided. I reserve the right to cancel/postpone the class if a minimum of 8 participants do not register for the class. You will be given a full refund for registration fees paid if the class is cancelled/postponed. If you decide to drop the course before the 3rd class, you will receive a refund of 50% of the registration fee. After the 3rd class refunds will not be provided.}  

^{4. ATTENDANCE}

^{The MBSR Meditation curriculum is designed to be highly interactive and experiential. Therefore, attendance at each class is essential. If you miss class, you will not be able to make it up but will be able to access the Zoom recording of the class. The course requires a commitment to attend all 8 classes, complete home practices assigned weekly, participate in a 6-hour retreat, and finish the course.}

^{5. ACTIVE PARTICIPATION}

^{During the course we will work together to create a safe and supportive environment to learn and grow together. Most of what you learn from this experience will result from your active participation during class and by completing home practices. Your participation in the class is voluntary. You may experience mental and/or physical discomfort during parts of the class. You will be invited to practice some mindful movements and yoga stretches as part of the class. It is your responsibility to do the exercises with awareness, paying attention to your body to prevent an injury.}

^{6. HOLD HARMLESS}

^{You are responsible for the care of your body, mind, and soul throughout the course. You can stop participating in any activity at any time if you choose. You agree for yourself, your heirs, administrators, personal representatives, and assigns, to hold harmless the instructor, Dr. Brenda Butterfield, and any and all of her associates, employees, volunteers, agents successors, or assigns, for any and all liabilities, losses, costs, claims, demands or causes of action, past, present and future, know or unknown, relating to any actions in the class or any harm, physical or mental, that results from your participation in the course, and agree to indemnify the Released Parties for all judgements, costs, attorney fees and other expenses incurred as a result of a breach of this agreement.}

^{7. CONFIDENTIALITY}

^{I, Dr. Brenda Butterfield, follow the confidentiality ethics of the American Counseling Association as well as State and Federal confidentiality laws. Specifically, this means that your confidentiality is secure with me. In cases of child abuse or intent of physical harm to self or others, I am bound by law to report or seek additional help. See note below regarding HIPAA compliance.}

^{You agree that all communication during this course is confidential. You understand that each class and the retreat will be recorded on Zoom and access to the recordings will be provided to only those in class. You agree to respect the privacy of others in class by not sharing the Zoom recordings with anyone and/or agree to no discuss anything that happens in class outside of class. You agree to not approach class members outside of class about anything said in class without getting permission from them first.}

^{8. TERMINATION}

^{You understand that at her sole discretion, the instructor, either in the interest of the group or of yourself may withdraw you from the class.}

^{9. INFORMED CONSENT}

^{You acknowledge that you have read this entire document, that you understand its terms and provisions, that it is a binding agreement, that by signing it you are giving up substantial legal right you might otherwise have, and that you are signing it knowingly and voluntarily.}

^{Our New Experience (O.N.E.), LLC is committed to protecting your health information. We are required by law to: maintain the privacy of your protected health information or PHI; give you a notice of our legal duties and privacy practices with respect to your PHI; and follow the terms of the Notice currently in effect. This Notice of Privacy Practices is required by the Privacy Rules of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we use and disclose information about you, called protected health information, to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition, or the provision or payment of your health care. This Notice of Privacy Practices applies to all PHI used to make decisions about your care that we generate or maintain. Different privacy practices may apply to your PHI that is created by other people or entities or kept by other people or entities.}

^{Our New Experience (ONE), LLC: Brenda S. Butterfield, EdD, MSW, LMHC August 2022}