Expression of interest form.
Meditation, relaxation and empowerment classes & workshops for children and parents. Mindfulness & Relax Kids classes.
Adult sessions - Name
First Name
Last Name
Mobile Phone Number
-
ie.07797
Phone Number
Childs name
*
First Name
Last Name
Childs date of birth
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Parent/Guardian's name
*
First Name
Last Name
Mobile Phone Number - if not provided above
-
ie. 07797
Phone Number
E-mail
*
Relationship to child
Which classes are you most interested in ?
Relax Kids classes & workshops. 6-9 yrs
Chill Skills classes & workshops. 9-13 yrs
Parent & child classes 6-9 yrs
1 to 1 sessions. All ages
Relax in Nature (outdoor classes). 6-9 yrs
Chill in Nature (outdoor classes). 10-13 yrs
Relax it's bedtime classes. 6-9 yrs
Anxiety classes. 6-9 yrs
Peaceful Parents classes - Mum's & Dad's
EFT/Reiki/Aromatherapy for parents and children
Other
Please complete the following to the best of your current knowledge. You can comment in the space below or contact me via email innerspacejersey@hotmail.com to discuss any specific concerns you have and together we can support your child.
Rows
Excellent
Good
Okay
Needs some support
Would benifit from extra support
Ability to be calm and peaceful at all times.
Ability to deal with anxiety and stress.
Ability to express their feelings.
Self-esteem and self-confidence.
Ability to cope with feelings of anger.
Ability to openly show care and concern for themselves and others.
Attention span.
Ability to listen.
Sleep pattern.
Please tell me about your child. You can provide below any further information that you feel is relevant about your child. For example a medical condition, awaiting diagnoses or current emotional/behavioural difficulties etc.
Class time preference - A helpful guideline to assist me with scheduling classes.
After school 4-5 pm
Saturday morning.
Saturday afternoon
Evening 6-7pm (parent & child/parent classes & bedtime classes)
Daytime morning (parent classes)
Daytime afternoon (parent classes)
Not bothered - any time :)
Other
Comments? Please feel free to let me know how I can best serve your family's needs. What do you need help with? Are there any other classes or workshops you would like to see offered?
Submit
Thank you for expressing an interest in Inner Space Jersey-Relax Kids classes and workshops.
I will be in touch to offer you a space as soon as a place in a suitable class becomes available. You will be notified of upcoming classes before they get advertised on Facebook to have first opportunity of securing a place.
Should be Empty: