Developing Teaching Skills Booking Form

Developing Teaching Skills

Registration Form
Booking Information
OpenCRM Event
Choose your dates below:
Please select the rate you will be paying:
If an organisation is paying, please provide invoicing details:
To pay the Stage 1 Bundle, you must fill in the more detailed application form for Mindfulness Facilitator A so we can assess whether you have fulfilled all the prerequisites for Stage 1. You can access the form here.
Stage 1 Bundle means paying for all Stage 1 modules at once and receiving a discount of 10%. If you would like to request a payment plan, please let our training team know by email when they confirm your place.
Please tell us some basic information
Name:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
E-mail 2
example@example.com
Mobile Phone
Home/Work Phone
Date of Birth

DayMonthYear
Gender
What pronouns do you use?
Ethnicity
Your Practice
I am taking Developing Teaching Skills...
Please tell us if you have trained to teach any of the following:
Please tell us a bit about what you hope to get out of your experience on the 'Developing Teaching Skills' course
Will you be continuing on to take the full Breathworks Teacher Training?
Health and Accessibility Information
Do you currently have any physical health conditions?
If yes, how does this condition affect your ability to hear, see, sit, stand, walk or engage in mindful movement?
Have you had any mental health issues within the last few years (such as anxiety or depression)?
If yes, have you ever, or are you currently receiving treatment?
We want to make sure that your Breathworks training is as accessible as possible. If you have any access or communication requirements (eg. related to dyslexia, neurodiversity, physical or mental health conditions, sensory impairment, restricted mobility etc) please give details here:
Emergency Contact
Please provide contact details for who we should contact in case of an emergency when attending a programme with us.
Emergency Contact Name
Emergency Contact Phone Number

Area CodePhone Number
If there is an incident/accident/ flare up of your health condition during one of our events, is there anything we need to know to help get you the support you will need? eg list of medication, usual steps you take
Keeping in touch
How did you hear about Breathworks
Communication Preferences

We'd love to add you to our mailing list so you can enjoy our monthly mindfulness newsletter and be the first to know about events & promotions we think you'll love. We'll keep you present, not pestered. If you're happy to hear from us, please tick the box below.
Newsletter
Activity subject
Date of submission

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Developing Teaching Skills

Booking Information

Please tell us some basic information

Your Practice

Health and Accessibility Information

Emergency Contact

Keeping in touch