still method

School Still Early Group Registration Form

Provided by Sunny Connections Cic/Sunny Horizons Coaching
Which Programme would you like to register for?
Child's Name

First NameLast Name
Age
Name of School attended by your Child?
Parent/Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Numbers to Ring in case of Emergency & Relationship to the Child.
Contact Name

First NameLast Name
Relationship To Child
Phone Number

Area CodePhone Number
Contact Name

First NameLast Name
Relationship To Child
Phone Number

Area CodePhone Number
Name of parent/carer?
Will you be attending sessions with your child?
Please give brief detail
Does your child have Epilepsy? If Yes, please advise your coach as some exercises may trigger a seizure
Does your child have severe allergies/anaphylaxis? If your child requires an epi-pen, please make sure they can be assisted if needed.
Does your child have Asthma? If Yes, please ensure they bring their inhaler
Is your child taking any medication? If Yes please give details
Please give detail
Please complete the following to the best of your knowledge and discuss any specific concerns you have with me and together we can support your child.
Please tell us a little about your child - do they have any specific anxiety or self confidence issues which may affect them including emotional or behavioural problems? If you wish to discuss further with Kate, the coach, please email her at sunnyhorizons@btinternet.com
How did you hear about Sunny Horizons/Connections and the STILL Method?
STILL Method Clubs include movement, stretches, visualisation, breathing exercises. Do you consent to your child being involved?
Signature
Date/Time
Should be Empty:

School Still Early Group Registration Form