Consent Form | YUME Meditation

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Personal Details

Full Name*

Preferred Name

Date of Birth*

Phone*

Emergency Contact (optional – used only if a health or safety incident occurs)

Health & Wellbeing

Do you have any health conditions or injuries that may affect participation?

Are you currently taking medication or receiving medical/psychological care?

Have you ever experienced discomfort (emotional or physical) during relaxation or meditation?

Is there anything that may affect your ability to sit or lie comfortably?

Meditation Experience & Goals

Have you meditated before?

Yes

Main reason for attending YUME Meditation

Stress relief

Sleep

Focus

Emotional balance

Spiritual growth

Other

Preferred guidance style

Structured instruction

Gentle verbal cues

More silence

Consent & Privacy

I understand meditation is a wellbeing practice, not a medical or therapeutic treatment.

I am responsible for my physical and emotional wellbeing during sessions.

I consent to YUME Meditation collecting and securely storing my information for safety purposes.

I acknowledge information will only be shared if required by law or in an emergency.

Privacy Statement

YUME Meditation collects your personal information solely for safe session delivery, in accordance with the Privacy Act 1988 (Cth). Your data is stored securely and accessed only by authorised facilitators. You may request access or deletion of your data at any time by emailing hello@yumemeditation.com

☑ By ticking this box, I confirm that I have read and agree to the Privacy and Consent terms above.*

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Breath-led meditation to restore clarity, balance and connection in person or online.

YUME supports your system to find its own rhythm.

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