• Participant Informed Consent & Release Agreement

    Please keep a copy of this document for your records. Once you submit your agreement, a copy will automatically be sent to the email address you provide below.

  • Overview:

    Eat Breathe Thrive is a nonprofit organization that aims to support individuals dealing with food and body image challenges. Programs are offered by trained facilitators in community spaces, yoga studios, universities, schools, and other settings. Your facilitator may be a yoga teacher, mental health practitioner, or educator.

    This program includes six two-hour sessions and a final service activity you will plan and execute together with fellow participants. Each session includes discussion, interactive exercises, movement, and meditation.

  • Risks and Benefits:

    The program may have benefits and risks. You should consult with your physician and obtain consent prior to beginning the program.

    All movement programs involve a risk of injury. By choosing to participate in the movement portion of each session, you voluntarily assume a certain risk of injury. The following guidelines will help you reduce your risk of injury:

    • Breathe smoothly and continuously as you move and stretch.
    • Do not strain to attain any position.
    • Respect your body’s abilities and limitations.
    • Do not perform postures or movements that are painful.
    • Consult your healthcare provider if you have previous injuries or conditions.

    You may experience uncomfortable feelings over the course of the program. Some participants report feeling sadness, guilt, shame, frustration, and overwhelm during group discussions. Some aspects of the program may elicit uncomfortable memories.


    This program also carries the possibility of many benefits. Many participants report reduced stress, improved self-esteem, improved mood, greater satisfaction with their body, better communication skills, healthier eating behaviors, and a sense of meaning and purpose. It is not unusual for people to sometimes feel worse before they feel better. It is important to note that there are no guarantees of what you will or will not experience.

  • Medical Concerns:

    This program is not a treatment for any mental or physical illness. It is not a substitute for medical or mental health treatment. Your facilitators cannot diagnose or treat mental or medical conditions. It is recommended that you seek counsel from qualified medical and mental health professionals for issues related to psychological and physiological illness.

  • Your Rights:

    1. You have the right to ask questions about the process and course of the program.
    2. You have the right to voice concerns or complaints about the program. Your facilitators welcome your feedback directly. In addition, you can contact the Eat Breathe Thrive Organization with any concerns about unethical or unfair treatment by the facilitator(s).
    3. You have the right to leave the program. If you wish, your facilitator(s) will provide you with the names of other qualified professionals whose services you might prefer.
    4. You have the right to expect that the facilitators will maintain professional and ethical boundaries. The Code of Ethics your facilitators abide by are explicated here .
    5. You have the right to set your own physical and emotional boundaries. If there are any aspects of the program you do not wish to participate in, you have the right to opt out. If you do not wish to engage in activities that involve touch, you have the right to opt out.

  • Confidentiality:

    Your facilitator(s) are required to maintain your confidentiality, and we ask that you respect the confidentiality of your fellow participants. Keep what happens in the group in the group. If you want to share what you are learning about yourself with friends or loved ones, remember not to share names, identities, or in any other way compromise the confidentiality of your fellow participants.

  • Limits to Confidentiality:

    Your facilitator(s) are required to maintain your confidentiality, except for a few special circumstances:

    • Instances of active or suspected abuse (physical, emotional, or sexual) or neglect of a child, an elder, or a dependent adult must be reported to the appropriate protective services.
    • If you threaten to harm yourself or to harm another individual, facilitators are required to take steps to help maintain the safety of the person at risk.
    • If a judge orders a facilitator’s testimony/records or, in the context of a legal proceeding, the facilitator may be required to release confidential information to the court.
    • The facilitator(s) may consult with the Eat Breathe Thrive Organization and its staff about what happens in the program.

    Your fellow participants are asked to sign the same confidentiality agreement you do prior to entering the program. The Eat Breathe Thrive Organization and your facilitators cannot guarantee that fellow participants will uphold confidentiality standards.

  • Safety Factors:

    This program is not intended for individuals struggling with acute mental or physical illness. If you engage in any of the following, you will be asked to leave the program for the safety of you and your fellow participants:

    • Use of drugs or alcohol before or during sessions.
    • Purging
    • Laxative/diet pill/stimulant abuse
    • Self-harm behaviors

  • Attendance:

    Your presence in every session is important. A healthy group dynamic is essential for healing, growth and change. If you are absent, this dynamic suffers and affects the experience of you and other members of the group. We ask that you make a commitment to attending every session of the program.

    An emergency may occur that prevents you from attending a session. If you are faced with an emergency or sudden illness, please contact your facilitator(s) before group begins let them know you will not be present.

    If for some reason you need to leave the program before its conclusion, we ask that you attend a final session to let your fellow participants and facilitators know you are leaving. We ask this because each member of the group is important, and your presence and your departure will impact everyone involved.

  • Emergency Contact:

    Your facilitators will make every effort to return any contact you initiate (email, phone call, text, etc) in a reasonable amount of time. Should you have an emergency that requires immediate attention or action, call 911 or go to the nearest emergency room.

  • Records:

    The Eat Breathe Thrive Organization maintains outcome data for all programs. These records include questionnaires you fill out, billing records, and copies of any professional documents (e.g., informed consent forms, media releases, etc). These records may be used for qualitative and quantitative research, but any identifying data will be removed to avoid revealing your identity.

  • I have read the above information, understand the information, and agree to the terms of group participation.

  • Should be Empty: