Mindful Self-Compassion 8+1 Week Program Registration Form 2022 2023

Mindful Self-Compassion 8+1 Week Registration Form

Loving Connected Presence

I am registering for

Name

NRIC number/ Passport Number (non-Malaysian)

Address

Phone number

Age

Gender

Profession/ Student/ Not working

How did you find out about this program?

Please state if from referral / non of the above

Why are you interested in participating in this program? (MSC is designed for personal growth and development)

Are there any stressful life circumstances that might make this program difficult for you at this time? (e.g., past trauma, recent loss of a loved one or job, substance use, fasting, etc.).

Are you currently seeing a psychiatrist/psychologist/counselor?

If yes, please provide contact information for us to contact your psychiatrist/ psychologist/counselor in the unlikely event of a psychological emergency.

Do you have any illness or limitation or taking medication that may impact your participation in the program?

If yes, please describe

Is there anything else that might be helpful for the MSC teacher to know at this time?

Please read the terms and conditions below:

1. I understand that, my participation in this MSC 8+1 week program is entirely voluntary and I am free to withdraw at any time during the program without penalty or prejudice except for the non-refundable fee. At the present time, I am planning to participate in the entire program.

2. I understand that, registration of this program is only offered to individuals who have received at least 2 doses of Covid-19 vaccination and preferably have taken booster dose. I will update my MySejahtera profile status and show the organizer my vaccination e-certificate before entering the venue of this MSC 8+1 week program (InPsych’s centre).

3. I will put on my face-mask and will observe Covid-19-related SOP at all times when I am attending this MSC 8+1 week program.

4. I understand that, all participants, the teacher and the organizer (staff on duty), are required to administer a COVID-19 self-test and to complete a HEALTH DECLARATION FORM (online) on the night prior to the weekly session of this MSC 8+1 week program.

5. I understand that, this MSC 8+1 week in-person program may change to an online program:

(i) In the event that COVID-19 pandemic worsens prior to the program dates, it may be switched to online format using Zoom

(ii) If any of the participants is COVID-19 positive or becomes a close contact, online session will be adopted for the involved person only. The rest of the participants will resume the in-person sessions.

(iii) If the teacher is COVID-19 positive or becomes a close contact, the session will be switched to online format if the teacher is feeling well to teach or it may be postponed until the teacher recovers fully.

By submitting in this Registration Form

I understand and accept all the terms and conditions listed above and in the program website, on attending this MSC 8+1 week program.

Mindful Self-Compassion 8+1 Week Registration Form

Loving Connected Presence

Please read the terms and conditions below:

Address List

Psychological Services

Learning & Development

Payment

InPsych Psychological Services & Training

We have received your registration.

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