Mindfulness Now Class Information and Booking Form

Mindfulness Now Class Information and Booking Form – 8 Weeks Programme

This information sheet sets out some basic information about the classes that you are attending, as well as briefly asking you a few questions. It is deliberately kept to a minimum and I ask you to read it please and, as required formality and complete the form in order to secure your place on the class.
I am diagnosed with epilepsy. If yes,....
this is inactive/controlled by medication
I have serious breathing difficulty/asthma
If yes I carry my inhaler with me .
I am diagnosed with a serious psychiatric illness (other than depression *
I have serious suicidal thoughts *
*If (yes) to either of the above question 2 questions please provide brief details or discussprivately with one me if you prefer:
Anything else you think it would be usefulto share with me/ Any Help Needed?
Privacy Notice

We are required by law to inform you that we intend to hold, in secure paper and electronic format, only basic information, as contained in this form, including brief contact information, purely for the purpose of providing these classes and so that we can update you on any class cancellations etc, and send you further supporting information on mindfulness. You are entitled to request the return of this information at any time.
I am happy for my basic contact information to be retained for the above purposes...
Contact Information
Name

First Name Last Name
Address

Street Address

Street Address Line 2

Town City

Post code
Phone number
Email
example@example.com
Next of kin name and contact number for emergency use only:
Doctor’s name and address, for emergency use only
Would you like to partake in a group mindfulness class or one to one lessons?
Today's date

Month Day Year
Date
Signature

Clear
Purpose of the weekly classes

The purpose is for you to learn and practice mindfulness meditation in a group setting. Each of the 8 weekly sessions provides an opportunity for further practice and learning. Home practice is also required. There is sound, scientific evidence that mindfulness, particularly when practiced over a period of 8 weeks or more, can help to avoid depression, as well as reducing anxiety, stress and panic symptoms. It can also promote wellbeing and resilience. It’s important to say that this is not ‘group-therapy’. We do encourage some informal discussion but this is focused around responses to the mindfulness practices experienced in the session as well as how attendees are getting on with mindfulness practice in between classes. No pressure is ever put upon any attendee to speak.

One or more qualified mindfulness teachers are in attendance at each session and, as well as facilitating the class, are available after the class finishes to chat briefly with any participants on an individual basis.

Looking After Yourself

The practices in each class involve sitting as well as occasional standing and gentle movement. Nothing vigorous is involved and please only do what is safe and suitable for you, based upon your state of health. If in any doubt please consult your doctor. Mindfulness is safe for everyone provided that we observe simple precautions.
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Mindfulness Now Class Information and Booking Form – 8 Weeks Programme