Participation
Mindful Switch Non-Clinical Personal Programs are designed to teach participants the tools needed to develop and cultivate a mindfulness practice and support the generalized population in managing stress, anxiety, chronic pain and cultivating self-compassion.
As such, I understand and confirm that:
I voluntarily agree to participate in activities involved in the 8-week Non-Clinical Personal Programs offered at Mindful Switch. I hereby assume all risks of injury to me and my property that may be sustained in connection with activities and teachings undertaken during the program. I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue the facilitator(s) from liability from any and all claims.
I assume responsibility for having or obtaining access to a primary care physician and/or a mental health professional for the duration of this program. This may include access to a counsellor, therapist, community health centre, walk in clinic, campus health services or other forms of primary care.
In the case of a crisis or emergency, I will go to the nearest emergency room or access suitable health services. I am responsible for understanding how to access emergency services in my physical location.
I understand that I must provide the name and contact details of an emergency contact person in an intake form in order to attend and participate in the personal programs.
I understand that the facilitators are not expected or able to provide medical and/or psychological care. I agree that, in the event a facilitator determines that I need urgent professional medical or psychological attention, the facilitator has the authority and sole discretion to contact the designated emergency contact person or 911 emergency services.
I acknowledge that I need to attend at least six (6) full sessions to receive a certificate of participation for this program.
I understand that Mindful Switch and the facilitator of the program is not responsible for my healthcare and has no liability around my healthcare.
I understand that any costs incurred for health services are my sole responsibility and not the responsibility of the facilitator(s) or the course facility.
I agree to indemnify Mindful Switch and/or facilitators any expenses they incur on my behalf as they relate to the services I will be receiving in the program.
I further understand that participation in a personal program is at the discretion of the facilitator(s) at all times. If, in the opinion of the facilitator(s), I am unable to continue to participate productively in the course, I may be asked to withdraw from the program.
If I am taking prescription medications of any kind and discontinue taking them during the program, this may be grounds to be asked to leave if it is having an effect on my ability to participate in the program or having an impact on the other group participants.
If I have been abusing drugs, alcohol and other substances, it is my responsibility to let the facilitator(s) know. I assume full responsibility for my participation in the program and for having access to the appropriate health care and health care professionals.
I understand that personal safety and emotional wellbeing are the foundation of mindfulness training and that I am primarily responsible for my own safety. I will not push myself to do anything that feels distressing or harmful. If I feel overwhelmed, I will stop what I am doing or slow down until I feel comfortable again. If I need to discuss a personal matter, I can consult with a facilitator, but I understand that the opinions of others are not a substitute for caring for myself in the best way I know.
All disputes arising out of or in connection with this agreement, or in respect of any legal relationship associated with or derived from this agreement, will be finally resolved by arbitration under the Simplified Arbitration Rules of the ADR Institute of Canada, Inc. (the “Rules”). This arbitration is to be conducted in English by a single arbitrator appointed in accordance with the said Rules. The seat of the arbitration shall be Canada. The arbitration shall be held by way of video conference, and the governing law shall be the laws of Canada. The award rendered by the arbitrator shall be final and binding upon both parties.
The governing law of this Agreement shall be the laws of Canada without reference to its conflict of laws principles.
The Parties agree that if, for any reason, a provision of this dd is held unenforceable by any court of competent jurisdiction, this Agreement shall be automatically conformed to the law, and otherwise this Agreement shall continue in full force and effect.
I have read this agreement and fully understand its contents. I sign it of my own free will. I am of legal age and accept the above disclaimer and authorization.
Confidentiality
I understand that I must protect the confidentiality of other participants in this program, and I confirm my agreement with the following statements:
• I must not make notes of participant names or of anything that might uniquely identify other participants in the program, including their name, location, profession, etc.
• I must not record, photograph, or screen capture any part of any of the group sessions.
• I must always login to group sessions from a private location where the screen and the voices of other participants cannot be seen nor be heard by others in my space.
• I understand that any breach of confidentiality will result in my removal from the session and potentially from the program.
Limits to Confidentiality
Mindful Switch acknowledges privacy concerns, and we maintain privacy to the fullest extent possible. All communications between you and the program facilitator are confidential and the facilitator is the person that maintains and holds onto my intake form.
I understand that my communication with the facilitator is protected and treated as confidential and cannot be disclosed without my written and informed consents, except in the following cases:
• A court order or warrant is provided to Mindful Switch
• If you pose a significant risk to yourself or others
• Child Protection is involved
Privacy Notice: Collection of Personal Health Information
We collect personal health information about you directly from you or from the person actingon your behalf. The personal health information that we collect may include, for example, youname, date of birth, address, heath history, record of your visits to Mindful Switchand the support you received during those visits. We protect your information through our administration policies and by adopting appropriate safeguards and security measures.
USE AND DISCLOSURE OF PERSONAL HEALTH INFORMATION
We may use or disclose your personal health information to:
• Communicate with your various health care providers including your family physician and/or other health care institutions for continuity of care in order to treat/support and care for you
• Plan, administer and manage our internal operations, and conduct risk-management activities;
• Conduct quality improvement activities (such as sending client satisfaction surveys);
• Teach, conduct research (only under strict rules overseen by a research ethics boards) and compile statistics;
• Comply with legal and regulatory requirements; and
• Fulfill other purposes permitted or required by law.
We can assure you that only staff who need your personal health information for fairest care or administrative purposes are authorized to access your record of personal health information. A clients instructions cannot prevent us from recording information that is required by law, professional standards or our practice.
Electronic Communication
I understand that unencrypted email may not be secure for information between myself and the group facilitator. It may be accessed by others, accidentally forwarded, or exist indefinitely.
I agree not to communicate confidential information about myself or any other person using unencrypted email. I further understand that I should not communicate time sensitive or emergency information via unencrypted email nor the learning platform.
I understand and accept that Mindful Switch staff will communicate with me regarding administrative issues and my group facilitator(s) will communicate with me regarding program issues. I understand that should I wish to email Mindful Switch staff to discuss program concerns that they will relay the information to my group program facilitator via telephone and/or forward it to the facilitator(s) via email.
Email communication with Mindful Switch will be restricted to the following uses: scheduling, providing directions on how to join online sessions, providing course materials and instructions, and communicating general health and educational information such as our newsletters. I further understand that all electronic communication shall be governed by the Personal Information Protection and Electronic Documents Act (S.C. 2000, c. 5)
Video Conferencing
Online group programs, by their very nature, reduce the ability to maintain confidentiality. I clearly understand that security is not guaranteed in the video conferencing platform, the URL may be accidentally forwarded, and a breach of confidentiality may occur. Under those circumstances, I will not hold Mindful Switch nor the program facilitator liable for such a breach.
I also understand that video conferencing should not be used in the event of an emergency or anything else of a time sensitive nature.
Please note that you must consent to Video Conferencing to participate in this online program. To discuss transferring to an in-person program, contact Mindful Switch at info@mindfulswitch.com or 416 206 4601.
Consent
I have read this agreement and fully understand its contents. I sign it of my own free will. I am of legal age and accept the above disclaimer and authorization.
Please note that you must consent to the above to participate in any personal program with Mindful Switch. To withdraw from the program, contact Mindful Switch at info@mindfulswitch.com or 416 206 4601.