Full Name
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First Name
Last Name
Gender
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Date of Birth
Home Address
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Postcode
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Mobile Number
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Landline Number
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Area Code
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E-mail
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Emergency Contact Name
Emergency Contact Number
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1. What are your main reasons for choosing to undertake the Meditation Course?
2. Do you have any history of or are you currently affected by any physical illness or limitation(s) that may make sitting, lying or meditation walking practices difficult for you?
3. Do you experience acute or debilitating depression or any other mental health conditions? If so, please can you say a little bit more about this.
4. Will working in pairs or with a small group of people provide any challenges for you? If yes, please give some details.
5. Do you think there is anything else you should make me aware of (eg. mobility restrictions, hearing or visual impairment? Medication).
6. Attendance at all sessions is important to the group process. Are there any current circumstances that may make attendance at all sessions difficult for you? .
7. If you have experience of meditating, please give details.
8. Have you any questions?
Dates and Costs
Please select the date you want to attend
7th-14th April and 5th May 2019
If booking more than one date, please enter dates here.
Or choose a Drop in Date
7th, 14th April and 5th May 2019
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