The undersigned acknowledges that s/he has volunteered to participate in a workshop in which s/he engages in a hypnotic experiences, and that workshop participants and faculty will be present during this/these session(s).

Because this is a Skills Development Workshop, all participants are expected to attend the ENTIRE workshop and participate in all experiential exercises/activities, including experiential exercises.  NO EXCEPTIONS. The clinician acknowledges that s/he will arrange one’s travel plans and regular clinical and personal responsibilities in order to fully participate in the entire workshop. 

The undersigned does not have any medical or mental health problems or other special conditions that might interfere with their participation, except what has been disclosed to faculty members.

The undersigned understands that Continuing Education Certificates are distributed at the completion of the workshop, upon completion of the evaluation form.  Again, please plan your travel accordingly. 

The undersigned acknowledges that NPHTI reserves the right to withdraw from participation in the training workshop any clinician whose behavior significantly interferes with the group’s learning process, or is disrespectful and/or offensive to colleagues and/or faculty. NPHTI also reserves the right to withdraw participants who are not attending/participating in the entire workshop. 

The undersigned agrees to hold harmless NPHTI, MSCH, University of Minnesota Department of Pediatrics, and Minnesota Medical Association, their employees and members, the faculty, and other participants in the above described workshops, and indemnify them from and against any and all claims, damages, and costs arising from the undersigned’s participation in the above described workshops.

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All participants are expected to attend the entire workshop and participate in experiential activities, including hypnosis experiential exercises. Exceptions are not permitted. Participant Certificates are provided only to those attending the full program, and available at the conclusion of the Workshops on Saturday afternoon.