CBCT Registration - Emory School of Medicine Students
Fall Semester 2018

Please fill this form out to register for ONE of the two sections of CBCT (Cognitively-Based Compassion Training) offered free to School of Medicine students.  

This is a ten-week commitment and enrollment is limited.  We hope to accommodate all who are interested.  

Please do not register unless you can commit to attend the majority of sessions.  Note the course will be most useful if accompanied by an average of at least 10 minutes per day of meditation practice time.  Recordings will be provided each week for guidance, to accompany the topic of the week.

The course will meet in alternate rooms in the School of Medicine:  B-03 (lower level) and 190P.
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Class Time Preference *
Please indicate the course you would like to attend.  Courses run from August 13 - October 29, 2018.
Required
First Name *
Last Name *
Preferred Email Address *
In which degree program are you enrolled? *
Projected date of graduation: *
Have you enrolled in CBCT before? *
Briefly, how did you hear about the course? (Optional)
Optional Additional Comments
Liability Waiver *
All participants must read and digitally sign the following consent to participate, release, and waiver.  Participants in Cognitively-Based Compassion Training (“CBCT”) Events must understand and complete this waiver in order to register for CBCT courses. If you do not understand or agree to the waiver or have questions about it, please contact the Center for Contemplative Science & Compassion-Based Ethics at cbct@emory.edu before registering. I, the undersigned, consent to participate in a CBCT event and accept full responsibility for my health and voluntarily complete this Consent to Participate, Release, and Waiver of Liability. I agree to enter this consent, release, and wavier of liability. I understand and agree that the services and tools offered by the Center for Contemplative Science & Compassion-Based Ethics are not intended to replace or be a substitute for medical or psychiatric care. CBCT is not a therapeutic intervention for any disorders identified in the Diagnostic and Statistical Manual of Mental Disorders or any other medical reference, and is not intended to be used as such. I acknowledge that the CBCT event may at times make participants feel uncomfortable or vulnerable. By completing this consent, release, and waiver of liability, I assume all risks for any physical or mental consequences of participating in the CBCT event. By signing this consent, release, and waiver of liability, and in consideration for Emory University allowing me to participate in the CBCT event, I also specifically and expressly agree to hold harmless, indemnify, and release Emory University, and all training staff, and their respective employees, collaborators, agents, associates, and affiliates from any and all liability arising from my participation in the CBCT event or arising from the results of the educational guidance and other content that will be or has been provided in the CBCT event. I also acknowledge and agree that any personal information shared in the CBCT event by other participants is to be maintained as confidential. I will not disclose any personal information shared in the CBCT event outside the CBCT event or in any form of media. I further acknowledge and agree that participating in this CBCT event does not entitle participants to: i) teach or further distribute any content presented; or ii) represent themselves as sponsored by or otherwise affiliated or connected with the Center for Contemplative Science & Compassion-Based Ethics or Emory University. I understand that Emory University may terminate my participation in the CBCT event: (i) at any time in its sole discretion; or (ii) if I violate the terms of this agreement or Emory University Policies or Procedures. I have read this document carefully and I consent to and voluntarily choose to participate in the CBCT event described herein. I certify that I am at least 18 years of age, I am legally competent, and I am signing this document with full knowledge that it is a legally binding agreement under Georgia law.  By digitally placing my name in the following box, I understand that I have legally signed this document.
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