Grad MBSR Retreat Registration — Atlanta Mindfulness

MBSR Graduate Class Class Registration

Saturday, July 26 2025 9 am - 4:30 pm

(In order to participate, you must be able to attend the retreat in its entirety.)

Atlanta Friends Meeting, 701 Howard Street, Decatur, GA

Participant Name

First Name

Last Name

Phone

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Please share something about where, when, and/or with whom you took MBSR.

Waiver of Liability: I voluntarily agree to participate in this MBSR Retreat Class. I understand that this is a silent retreat and that activities will include sitting meditation, walking meditation, and gentle yoga. I realize that there may be unanticipated risks during such activities and I assume all risks of injury to me and my property that may be sustained in connection with my participation in retreat.

COVID Safety: In order to protect the safety and wellbeing of all retreat participants, I will refrain from attending class if I am feeling ill, have tested positive for COVID, or am in close contact with someone who is ill.

Audiovisual Recording: I understand that the retreat may be videorecorded and that the recording will be made available to any individual enrolled in this MBSR course who is unable to attend the Retreat Class.

Emergency Contact

Emergency Contact Phone

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Is there anything you would like share or anything that you have questions about?