Mindfulness Supervision training 2025/2026

first name *

middle name

last name *

M F other *

address *

zip code *

city *

country *

phonenumber *

email *

date of birth *

Meditation: please describe your meditation experience (tradition, practice, duration, number of years) *

Yoga: please describe your yoga experience (tradition, practice, duration, number of years, training – if applicable) *

Retreat experience: please describe your retreat experience (tradition, teachers, duration, number of retreats/years) *

Please describe your experience with teaching mindfulness, or applying mindfulness practices in your work: * yes no

Mindfulness teacher training: please describe the teacher training program(s) you have completed *

What is your motivation for this program? What do you hope to get out of it? *

Do you already have experience in giving supervision? *

How did you hear about this program? *

Is there any other information you would like to share with the teacher(s)?

Who may we reach in case of emergency? Please list phone number, name and relationship. *

Other personal information: Do you currently experience major health issues? If yes, please describe. Do you suffer from serious psychological problems, such as addictions, anxiety, depression? Are you currently in therapy? Do you take any medicine for your mental health? Please describe here. * * Please note: answering "yes" to this question does not automatically mean you cannot participate. Since psychological issues / complaints can influence your meditation practice, and vice versa, we like to get in touch with you personally before the start.

Additional comments:

Payment *

A prepayment of €195 is required together with your registration. This counts towards the payment of the program fee. You will receive payment details in the confirmation email.

€ 1.495,00

Cancellation policy

In case of cancellation, please notify us asap via info@lotheijke.com . For all cancellations, a E 50 fee applies. Cancellations received up to 8 weeks before the start of the program are entitled to a full refund (minus admin costs; up to 4 weeks before the start, a refund of 50% of the fee. For cancellations 4 weeks or closer before the start no refund is possible. It is possible to have a colleague participate in your place – after previous consultation and agreement from the teachers.

I understand that the teacher(s) and other staff decline all liability for any damage occuring to my person or my possessions in connection with this program.

* I agree with the terms and conditions and I register for: Mindfulness Supervision training 2025/2026 - 07-02-2025 until 08-02-2026.

After submitting your registration, you will receive an email with the invoice for the program.

Registration Mindfulness Supervision training 2025/2026