Mindful Self-Compassion 8 Week Program Registration Form

Mindful Self-Compassion 8-Week Registration Form

Loving Connected Presence

Full Name as per NRIC/ Passport

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-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 MSC 8-Week program

2. I understand that, this MSC 8-Week program is offered as a hybrid program, both in-person and online sessions are available. Online sessions will be using Zoom and there will be recording of each week/session, so that participants who missed that week/session will be able to view and catch-up before the following week/session. All recordings cannot be shared with/viewed by others (e.g. InPsych’s staff or anyone not in this program) and all the recordings will be deleted 2 weeks after the end of the program.

3. In the event of any infectious diseases or any health threatening situation occurring in the country prior to the program dates, the program may be switched to online format fully.

4. If any of the participants who enrolled for in-person sessions is unwell or affected by any infectious diseases or any health threatening situation, please attend the online sessions or view the recording or request to postpone to the next batch if medically unable to attend and complete the current program (submit medical report).

5. If the teacher is unwell or affected by any infectious diseases or any health threatening situation, the sessions will 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-week.

Mindful Self-Compassion 8-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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