Student Meditation Sutra Form

Student Meditation Sutra Form

Student Information

Date of Birth:    Student ID:

Parent / Guardian Information (if student is a minor)

Relationship:    Phone:

Program Enrollment & Schedule

Program Start Date:    Session Frequency:

Medical & Emergency Information

Relationship:    Phone:

I authorize school personnel to secure emergency medical treatment for the student when deemed necessary and understand that I will be responsible for costs associated with such treatment.

Consent, Policies, and Acknowledgments

Participation: I permit the student to participate in guided meditation sessions and sutra recitation exercises conducted by the program instructor.

Religious / Cultural Content: I understand that sutra recitations may include material derived from religious or cultural traditions. I consent to the student's exposure to such material in an educational, non-proselytizing context.

Alternative Secular Option: I request that the student be offered a secular mindfulness alternative when sutra recitation or explicitly religious practices occur.

Code of Conduct: I acknowledge that the student must adhere to program behavioral guidelines including respect for others, refraining from disruptive conduct, and respecting cultural practices. Violation may result in removal from sessions.

Confidentiality: I understand that personal disclosures made during practice may be considered confidential by instructors, and I will respect the privacy of other participants. Instructors may disclose information if required to prevent harm or by law.

Media Release: I authorize the use of photographs, audio or video recordings of the student by the school for legitimate educational or program-evaluation purposes. I understand recordings will not be used for commercial sale.

Waiver, Indemnification, and Legal Acknowledgment

By signing below, the signer acknowledges and agrees that participation in meditation and sutra recitation involves minimal physical risk but may involve emotional or psychological responses. To the fullest extent permitted by law, the signer releases, waives and forever discharges the school, its board members, employees, volunteers and agents from any and all liability, claims, demands, actions or causes of action arising out of or related to any loss, damage or injury that may be sustained by the student in connection with participation, except to the extent caused by the gross negligence or willful misconduct of the school.

The signer further agrees to indemnify and hold harmless the school and its representatives from any third-party claims resulting from the student's participation, including reasonable attorneys' fees and costs, unless such claim is the result of the school's gross negligence or intentional misconduct.

This authorization and release will remain in effect for the duration of the program and for any subsequent session dates identified in this form unless revoked in writing by the signer and acknowledged by the school. Revocation does not apply to actions taken prior to receipt of the revocation.

Accommodation Request

Acknowledgment of Understanding

I have read this Student Meditation Sutra Form carefully, understand the contents, and agree to the terms set forth above. I certify that the information provided on this form is accurate to the best of my knowledge. I understand that falsification of medical or emergency information may result in removal from the program.

I certify that the information provided is true and accurate.

I acknowledge participation is voluntary and that I may withdraw consent by providing written notice to program administration.

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