Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

What is your NI volunteer level?

First time

TA

ST

JT

I don't have an NI volunteer level

Are you currently practicing as a CHSE? *

Yes

No

Day 1 - Saturday

All Day

Specific times (share below)

Day 2 - Sunday

All Day

Specific times (share below)

Day 3 - Monday

All Day

Specific times (share below)

Day 4 - Tuesday

All Day

Specific times (share below)

Day 5 - Wednesday

All Day

Specific times (share below)

Day 6 - Thursday

All Day

Specific times (share below)

Day 7 - Friday

All Day

Specific times (share below)

Day 8 - Saturday

All Day

Specific times (share below)

Day 9 - Sunday

All Day

Specific times (share below)

Professional liability insurance is required to volunteer for the HSE training. Are you currently insured? *

Yes

No

Once accepted you will need to contact your insurance company and add Get Out Of Shape LLC. as additional insured through a specific endorsement to your policy. You will need my address for your insurance company 107 Ridgely Ave. 14C, Annapolis, MD 21401, United States. Once completed send a copy of the Certificate of Insurance to Ryan@RyanMoschell.com, or upload and click the "Agree and Submit Volunteer Application" button below. (Volunteers who do not live in the United States or Canada must seek out coverage for online education overseas or in the United States. I cannot help you with this and will need you to do your own research on how to get insurance coverage) *

Do you agree to complete this before the module begins?

Yes

No

Student Policies -Online *

1. Respect our Zoom classroom and this space as a place for learning. a. Please think of this Zoom room as reserved for Hanna Somatic Education only. b. Please keep yourself muted when you are not actively speaking. c. During class time we ask for your undivided, undistracted attention. d. Be respectful of the whole group and yourself. Inappropriate and snide remarks, hurtful language, or putting someone down have no place in an environment conducive to creative and thought-provoking learning. e. Please be aware and respectful that others in the group may not appreciate your sharing your political, religious, or spiritual views in the classroom. f. Be mindful of your video background as everyone will see what is in your video cameras sights. g. There are no dumb questions. If you don’t understand something, probably many others don’t understand it either. The training team wants you to get it! Ask! h. HSE is science based and frequently uses the language of science, physiology, and neurophysiology. 2. Audio, Photo, Video Recording Policy: a. The Training Sponsor reserves the exclusive right to audio, photo, and/or video record in-class activities / presentations during this HSE Training Program. b. By enrolling in this HSE Training and by signing this “Student Policies” document, I give my consent / permission to be recorded. 3. Attendance Policy: a. Be on time or early. This means arriving with enough time for setting up your Somatic movement space with everything you will need, set up your camera so that your whole body can be seen in your Zoom frame, going to the bathroom, saying hello to friends, and being ready to start promptly at 9 a.m. It also means returning from breaks and lunch on time. b. Class ends at the scheduled time. Please arrange your life so you can be in class full-time. c. We may celebrate together with a group lunch. If scheduled please plan to attend this event from 12:00 to 1:30 p.m. d. Remember that the last day of each module ends at the usual time. Please make travel plans that enable you to attend the complete last day. e. Your camera being on is the way we know that you are present and in class. Please keep your camera on at all times during class unless you make arrangements with a teacher or co-coordinator. 4. Cell phones and other devices that make noise are not to interrupt class time. Either turn them off or set them to signal you in a noiseless way. Please only return calls and pages during breaks. 5. During breaks, please use the bathroom, make phone calls, have snacks, etc. right away, when the break begins, and then be back to class on time. Please familiarize yourself with the location of public restrooms. 6. Participation, participation, participation. The only failure is the failure to participate. We structure your practice time to enable you to change partners frequently. Different body types and people with different levels of expertise create the variety of learning experiences that will help you pass the ultimate test, working confidently with clients and building a practice. 7. Dual Relationships: Some of you may have friendships, professional, or family relationships with the training team or others in the classroom. These constitute a “dual relationship” situation. a. The training team wants to create an atmosphere free from favoritism or any expectation of entitlement. b. In the context of our HSE Training Program, whether in or out of the classroom, you’ll be wearing your “student hat” and the members of the Training Team will be wearing their “teacher or helper hats.” Please respect these roles throughout the HSE Training Program. c. Good friends may feel free to use language around each other that would be inappropriate in the classroom. For example, if another student is your friend, you may want to gossip or comment about something said in the class, that you wouldn’t think of doing if that person were not your friend. Please refrain from this in the classroom.

By checking this box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the terms of the HSE Student Policies and I understand that this is the legal equivalent to providing my electronic or written signature.

Scope of Practice for HSE Practitioners *

As a HSE Training Volunteer, I understand that the following represents the scope of the practice of Hanna Somatic Education® (HSE). This scope of practice is based upon the theoretical and applied principles of HSE as they are taught under the auspices of and sponsored by Get Out Of Shape LLC. - Hanna Somatic Educators provide verbal or hands-on somatic education services for individual clients or groups in order to improve the central integration of the execution of their sensory-motor activities. This may include but not necessarily be limited to endeavoring to: - Apply the HSE specific clinical processes of “means whereby”, “kinetic mirroring”, and “pandiculation” during their sessions and classes. - Educate and train individuals or groups in self-performed motor skill improvement processes, i.e., Somatic Exercises and Explorations. - Disseminate educational materials to the public, including, but not limited to HSE Somatic Exercises and related somatic arts, sciences, philosophy and principles through lectures, seminars, training programs if specifically licensed as a trainer by the Novato Institute, conventions, publications, audio or video tapes, or otherwise. - Develop, encourage, and or provide public benefit classes, and instruction in somatic movement, relaxation, reeducation forms and in somatic principles. - Generally, promote and develop somatic movement arts, science, philosophy and principles.

By checking the box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the terms of the HSE Scope of Practice and I understand that this is the legal equivalent to providing my electronic or written signature.

Code of Ethics of the for HSE Training *

This code of ethics provides governance for three main domains of concern: First, it specifies professional standards which allow for the proper discharge of Hanna Somatic Educators’ responsibilities to the clients they are serving; Secondly, it protects the integrity of Hanna Somatic Education® (HSE), the Association for Hanna Somatic Education®, Inc. (AHSE), and the professional members of the AHSE; and Finally, it safeguards the interests and persons of the clients under the care of AHSE practitioners. As a certified practitioner, or as a practitioner-in-training practicing under the limitations imposed upon pre-certified students of HSE, or as a Licensed Trainer of HSE, I agree that I will: · Hold a sincere commitment to providing the highest quality of care to all persons who seek out my professional services. · Represent my professional qualifications accurately, including education and professional affiliations, and provide only those services which I am qualified to perform by training and experience. · Inform the general public, clients, and other health care practitioners accurately about the scope and limitations of HSE practices. · Acknowledge the limitations of and contraindications to the application of HSE practices, and refer clients to appropriate health professionals as needed. · Provide HSE care only when there is a reasonable expectation that the care will be advantageous to the client. · Maintain and improve my professional certification, knowledge, and skills through ongoing assessment of my professional strengths and weaknesses, and through continued education and training. · Observe honesty and integrity in conducting my business and professional activities, and refuse to unjustly discriminate against clients or other ethical health professionals. · Safeguard the confidentiality of all client information unless disclosure is authorized by the client, required by law or court order, or absolutely necessary for the protection of the public at large. · Respect the client’s right to receive care with informed and voluntary consent. The consent may be either written or verbal and will be obtained before providing any HSE care. · Honor the client’s right to refuse, request modification of, or terminate care regardless of prior consent given. · Ensure the safety, comfort, and privacy of all clients in my provision of care. · Exercise my right to refuse to work with a person or part of the body for reasonable cause. · Refrain, under any circumstances, from initiating or engaging in any sexual conduct, activities, or sexualizing behavior involving a client, even if the client attempts to sexualize the relationship. · Avoid any influences, activities or interests which might conflict with my obligation to always act in the best interests of my clients or profession. · Follow all policies, procedures, guidelines, regulations, codes, and requirements put forth by the AHSE and by any governmental regulatory agencies. · Practice courteous professional relationships with HSE and allied professional colleagues.

By checking the box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the terms of the Code of Ethics as written above and I understand that this is the legal equivalent to providing my electronic or written signature.

Concerns Regarding Teachers and HSE Training Volunteers Fraternizing With Students *

1. Student takes on the bias of Teacher or HSE Training Volunteer 2. Favoritism; 3. Overwhelming the Student with too much information too soon or at the wrong time; 4. Harassment; 5. Unintentionally leading Students astray; 6. A Teacher or HSE Training Volunteer must exercise good ethical judgment / discernment that is in accord with the AHSE (Association for Hanna Somatic Education, Inc.) “Ethics Code” (see attached copy); 7. A Teacher or HSE Training Volunteer shall intentionally vary any Students and Student groups they relate with; 8. Pre-existing friendships or other dual relationships and how A Teachers and HSE Training Volunteer and Student must alter relationship during Trainings; 9. Avoid causing some Students to feel slighted by a Teacher or HSE Training Volunteer; 10. Respect / develop / preserve professional boundaries: be friendly but not familiar; 11. A Teacher or HSE Training Volunteer must keep perspective to be able to accurately evaluate Student’s readiness to certify; 12. If a Teacher or HSE Training Volunteer is in a social situation with Student, and HSE ‘shop talk’ comes up, it’s OK to clarify but avoid venturing into any new territory or teaching; afterwards, report relevant topics to Teachers for possible inclusion into Training to keep all students on an even basis; 13. A Teacher or HSE Training Volunteer must be cognizant of potential legal ramifications to avoid misperceptions / lawsuits; 14. Not fraternizing reduces possibility that Student will take-up too much of a Teacher or HSE Training Volunteer time; on the other hand, we want to have a friendly demeanor: remember that this can be a very fine line to establish and maintain; 15. Respecting all the concerns stated above, a Teacher or HSE Training Volunteer may accept appropriate social invitations from students. However, as the director of the HSE Certification Training program, Eleanor Criswell Hanna (or her designee) has the authority to request that a Teacher or HSE Training Volunteer refrain from any behavior that disrespects or jeopardizes the integrity of the HSE Certification Training Program. Failure to comply could result in the dismissal of the notified A Teacher or HSE Training Volunteer from the HSE Training

By checking the box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the terms of the HSE Concerns Regarding Teachers and HSE volunteers Fraternizing with Students and I understand that this is the legal equivalent to providing my electronic or written signature.

Agreement/Contract for Teachers and Volunteers in an Authorized HSE Training

The primary function of the HSE Training is to enable students-in-training to learn what they need to learn and to refine their clinical Somatics skills (e.g., handling, interpersonal, cognitive, theoretical, experiential, etc.) so that they can become more proficient certified practitioners of Hanna Somatic Education. The primary role of a HSE Teacher and HSE Training Volunteer is to “make it so” that the HSE Training fulfills its primary function. Criteria for serving as a Teacher or HSE Training Volunteer include (1) being certified as a Hanna Somatic Educator, (2) being available for the full 9-days of the Training module, and (3) maintaining a certified membership status in the Association for Hanna Somatic Education, Inc. Your primary role as HSE Training Volunteer is to help the Teachers in the HSE Training, to respect and preserve the integrity of the Training at all times and in all ways, to observe and learn what HSE Teachers do, and to fulfill whatever responsibilities and/or obligations necessary. The Teaching Team has learned that it is a great disservice to students to introduce too much information and/or too many variations too soon in the Training. Therefore, in fulfilling your role as an HSE Training Volunteer you also agree to observe, respect, and honor the Teaching Team’s decisions about boundaries, how to conduct, and how to pace the Training. This means that you absolutely agree to refrain from teaching anything that the Teaching Team has not yet taught and that you will restrain yourself from bringing-up anything that the Teaching Team has not yet introduced (i.e., if you are unsure whether the Team has taught something, you will decline any entreaties to teach that thing and you will also restrain yourself from volunteering anything that the Teaching Team has not yet introduced to the students). The Teachers also honor these same guidelines. Overview of guidelines, concepts, tasks and behaviors: The HSE Teacher Development Program is a work in progress. As such, the Teaching Team has identified the following items as key to your role as an HSE training volunteer. As a Volunteer you agree to: 1. Experience the HSE Training again but as a HSE Training Volunteer instead of as a student; 2. When requested, help document / outline teaching presentations, modules, discussions, etc.; 3. Be an able / willing volunteer ‘client’ in assessment modules, clinics, teaching demos, etc.; 4. Read case studies and neurophysiology papers as assigned; 5. Volunteering levels. Modules 1-6 – Experience an learn as much as you can always putting the priority on students. Assist Teachers during practice times when asked to do so. Modules 7-12 Master the curriculum and teaching methods, practice teaching, assist Teachers during practice times, and fully participate in the Training program when asked to do so. Modules 13-18 - Begin to co-teach the lecture and movement portions of the modules and make sure you become proficient in all aspects of the training. (See HSE Training Volunteer Readiness Scale). 6. Help collect, suggest, develop ideas for practice building and practitioner development modules; 7. Contribute in coordination times only when Co-coordinators invite you to; 8. Make punctual attendance and participation in the Training your #1 priority during the Training; 9. Attend and participate in meetings with Teachers at lunch and at other times as requested; 10. Respect and preserve the integrity of the Training by honoring the Training Team’s “Concerns Regarding HSE Training Volunteer Fraternizing With Students” (see attached copy); 11. Refrain from getting ahead of the Training program’s design and defer / refer protocol questions, etc. to the Teaching Team: this means that you agree to be attentive and to use good judgment / discernment about how you interact with students and their issues; 12. Conduct private HSE sessions with students according to the following parameters: a. HSE Training Volunteers agree to exclusively use HSE modalities with students; b. No sessions in the classroom; sessions may only be in your own or someone else’s space; c. HSE Training Volunteers shall charge their customary professional fees whenever they schedule clinical HSE sessions with students; d. Sessions shall not be “teaching” sessions — whether during or after the semester weeks; sessions shall address the student’s personal somatic needs; if there are observers of sessions, the HSE Training Volunteer agrees to refrain from interacting with the observer or turning the session into a tutorial; e. Refrain from scheduling private ‘tutoring’ sessions with students; only Teachers may do so; 13. Express your feedback concretely, explicitly, and in a positive, supportive, sincere manner; 14. Answer questions about personal handling differences without making wrong other Teaching Team members or practitioners of other methods; 15. Attend to and respectfully honor the Training’s and Teachers’ concerns / dangers / cautions; 16. Serve as a role model for all by precisely observing the Training’s schedule / timing at all times, returning promptly after breaks, giving your undivided attention to the speaker, following directions promptly, etc.; 17. Conscientiously do tasks that the Teaching Team asks you to do (e.g., retrieve student questions from the question / feedback receptacles, help set-up the room everyday, assist in the clinic, etc.); 18. Absolutely respect that all Training information, documents, hand-outs, discussions, etc. are confidential, private, privileged, and proprietary: this means that you will not disseminate anything you receive in the Training to anyone else who is not involved in the Training; 19. Keep your answers / comments to students short in order to maximize their practice / 1st person experience time: supervised practice is more important for the students than verbalization; 20. Learn how to run the Zoom portion of the training, run the slides, etc.; 21. Decline to openly compare your Training to this one (this one is somewhat different from yours); 22. Behave professionally at all times: this includes your demeanor, comments, respecting professional boundaries, etc. — remember, you are a role model; 23. Be aware that your future participation in Trainings depends upon your honoring these guidelines. “I have read, have clarified so I understand, and do hereby unequivocally promise to honor the spirit of and abide by the specifics of all the agreements, commitments, guidelines, concepts, tasks, behaviors, decisions, etc. set forth above so that I may participate in the HSE Training as an HSE Training Volunteer.”

by checking the box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the terms of the HSE Agreement/Contract for Volunteers in an Authorized HSE Training and I understand that this is the legal equivalent to providing my electronic or written signature.

Release of Liability

1. Inherent Risks and the assumption of Risk: I understand that there are inherent risks associated with Hanna Somatic Education, and hereby expressly assume all risks associated with participating in such activities. I, the participant/undersigned, acknowledge that I am responsible for self-regulating my own Somatic movements so that they are not forced or painful, and that I will take breaks or stop as I feel the need to do so. if needed I will get the proper clearance from my physician for gentle self-regulated movement practices. I assume all risks in connection therewith and expressly waive any claims for any injury or loss arising therefrom. 2. In consideration for the right to participate in this training, and/or to work with others in this training, including participating in the Hanna Somatics Education Professional Training & Certification Program online with Ryan Moschell, I (the participant/undersigned) hereby release Get Out Of Shape LLC and Ryan Moschell, their agents, contractors, associates, volunteers, employees and representatives from all liability whatsoever with respect to any injury (of the participant/undersigned), or any loss or damage to property of the participant/undersigned in participating in the Hanna Somatic Education training. 3. In-Person Trainings - I hereby consent to the administration of first aid and other emergency services in case of injury, and to the contacting of any emergency contacts and physicians listed in my student profile (or in the event that the listed physician cannot be reached via the contact information provided, any licensed physician) and ambulance services at the the expense of the participant/undersigned, if in the opinion of any representative of Ryan Moschell the circumstances warrant.

by checking the box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the terms of the HSE Release of Liability and I understand that this is the legal equivalent to providing my electronic or written signature.

Electronic Signature Acknowledgement and Consent

By checking the box below and clicking the ‘Agree and Submit Volunteer Application’ button below, each party acknowledges and agrees to the following: 1. Intent to Sign. You acknowledge that you are signing this agreement electronically and you agree that your electronic signature is the legal equivalent of your manual/handwritten signature on this agreement. By signing electronically, you agree to be legally bound by this agreement’s terms and conditions. 2. Electronic Delivery. You agree that any notices, disclosures, agreements or other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing. 3. Equivalent to Handwritten. You agree that your electronic consent, whether digital or encrypted, of this Agreement, is intended to authenticate this agreement, and to have the same force and effect as a manual/handwritten signature. 4. Electronic Storage. You agree that electronic copies of completed documents are valid, and you will not contest the validity of the electronic copies absent proof of altered data or tampering. Thank you for taking the time to read these documents! Once you pay your tuition for any HSE Module, this agreement will become effective immediately.

By checking the box and clicking the ‘Agree and Submit Volunteer Application' button at the bottom of this page, I certify that I have read, understand and agree to be bound by the Electronic Signature Acknowledgement and Consent outlined above.