A Meditation Therapy Retreat is an opportunity for you to examine your life, including your thoughts, feelings and behavior. You will begin the retreat with a statement or prayer concerning the areas of your life that you are interested in examining and changing, including spiritual, intellectual, emotional, material, and inter-personal areas. You may cover anything that is important to you. This should be a simple statement from your heart.

During the retreat there will be a variety of experiences, including meditation. Depending on the needs of the group, there may be time in nature, two person exercises, role playing and psychodrama, working with dreams, feedback from others, sharing before the entire group, movement, art, massage, metaphor therapy and gestalt therapy exercises.

Your job during the retreat will be to actively examine your own experience and to make fresh choices about who you have been and who you will be. You are always free either to leave an exercise or to remain but refuse to participate. It is important that you remain genuine and truthful and that you speak up about anything that may trouble you. It is your responsibility to obtain results from this workshop. The facilitator will work as effectively as he is able, but most of this work is intuitive because of the special needs of individuals and groups. In coming to this retreat, you accept responsibility for your own results and you agree not to sue for damages resulting from your participation.

Caution: People who have a weak sense of personal identity, who received inadequate attention from their mother or primary caretaker, or who hear voices or see visions that others do not see in the real world, may have difficulty in this workshop. They may suffer psychotic experiences that could require a stay in a hospital or mental health facility.

If you have been hospitalized for a psychiatric or mental condition, then you should consult with a psychologist or psychiatrist before deciding to take this Weekend, and you should bring a signed note stating that the psychologist or psychiatrist is satisfied that it is reasonable for you to attend. If you have any concern that you may not be suitable for this workshop, talk it over with Peter Bloch, at 416-656-9646. He may recommend that you be evaluated to help to assure your safety.

Confidentiality.   By attending this Weekend, you agree to keep confidential all statements made by any person other than yourself, unless you obtain permission from the person who made the statement. Every participant and the leader will make this same guarantee. However, you should know that the confidentiality of the workshop depends on the responsibility of every participant and cannot be guaranteed. In addition, under Ontario law, there are responsibilities to report child abuse, serious threats of suicide or crimes planned against others and to provide information required by court order.

I certify that I have read and understood this statement and that I voluntarily choose to attend the scheduled Meditation Therapy Weekend.

Signed:

Printed name:

Date:

Dates of Weekend: