Breath to Health Weekend Workshop Registration Form

Breath to Health Workshop Registration Form (Cohort 9)

Please fill out the form carefully for registration to attend our weekend Breath to Health Workshop (12th & 13th April 2025). All information you provide will be handled in strictest confidence and in line with GDPR guidelines. The cost to participate is £50 (heavily subsidised from £250 thanks to Moondance Foundation funding and support from the International Association of Human Values).
Name

First NameLast Name
E-mail
example@example.com
Mobile Number

How did you hear about us?

Word of MouthGPCounsellor or other Health ProfessionalFlyer / PosterInternet / Social MediaNewspaper / MagazineOther
Have you already attended the Mind & Body Wellness weekly sessions or a Breath to Health taster session?

YesNo

Terms & Conditions
I confirm that I am participating voluntarily in the Breath to Health Workshop

AgreeDisagree
By attending the workshop, I understand that when undertaking any breathing or yoga exercises, as is the case with any physical activity, the risk of injury is always present and cannot be eliminated. I voluntarily and knowingly recognise, accept and assume this risk.

AgreeDisagree
I have fully disclosed to the Instructor any conditions that I have or may have prior to participating in these Breath to Health sessions. Whilst it is acknowledged that personal injury and/or death resulting from negligence cannot be legally waived, I release and waive any other claims for negligence that I may now or hereafter have against Thriving Communities or the Breath to Health Project Team.

AgreeDisagree

Photography & Data Permissions
Thriving Communities and the Breath to Health Project Team may take photographs of me for any promotional materials including any of the following: social media, websites, flyers/posters. I understand I will not be identified by name.

AgreeDisagree
I agree to be added to an email list to be kept informed of future Thriving Communities and Mind and Body Wellness programme events (including the Breath to Health workshop series). I understand that my data will never be shared with a third party, and I can unsubscribe at any time.

AgreeDisagree
The data provided above will be stored and processed in line with GDPR guidelines in order that: my Instructor has knowledge of any injuries when teaching me; and I may be contacted in emergencies. I understand that I can withdraw my consent for my data to be held and/or processed at any time and that to do so I should contact Dr Manmeet Kaur at hello@thrivingcommunitiescic.org.

AgreeDisagree

Checkout
How do you wish to pay? NB: The workshop costs £50 and is heavily subsidised thanks to Moondance Foundation funding - original workshop cost £250.

Cash on the day - proceed to click the submit buttonBy bank transfer to Thriving Communities CIC, Account No: 76487539, Sort Code 51-61-02 (as ref use BTH-Apr25). Please select and click Submit button.Card payment - select the number of places below and submit your card details. Proceed then to click the submit button. You will get the payment confirmation in the Jotform registration email.

Please select the number of places you wish to pay for:

Breath to Health Weekend Workshop (Apr-25 - Standard FeeFee includes a royalty fee to International Association of Human Values

£50.00 Quantity

Breath to Health Weekend Workshop (Apr-25) - Premium Member FeeFee includes a royalty fee to International Association of Human Values

£45.00 Quantity

Total

£0.00

Breath to Health Workshop Registration Form (Cohort 9)