still method

Still 1-1 Registration Form

Provided by Sunny Horizons Coaching
Child's Name

First NameLast Name
Age
Parent/ Guardian's 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
Does your child have any known emotional or behavioural problems? If Yes, Please state in brief what and discuss this with your STILL Method Coach
Please give brief detail
Does your child have Epilepsy? If Yes, please advise 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 you are in the building.
Does your child have Asthma? If Yes, please advise coach & ensure they have their inhaler available
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.
Tell us a little about your child, how their anxiety or self confidence issues affect them.
How did you hear about Sunny Horizons and the STILL Method?
STILL Method Clubs include movement, stretches, visualisation, breathing exercises. Do you consent to your child being involved?
I consent to the above information being held confidentially in accordance with the terms of the Data Protection Act 2018
Signature
DateTime
Should be Empty:

Still 1-1 Registration Form