Breathe & Energise Retreat
Please complete the following form to register for our Breathe & Energise Retreat at Manmoel Village Hall on Saturday, 21st September (2pm to 5.30pm). If you have any questions about this, please email Esther at hello@thrivingcommunitiescic.org.
Name
*
First Name
Last Name
E-mail
*
example@example.com
Mobile Number
*
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Emergency Contact Name
First Name
Last Name
Emergency Mobile Number
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Any Current Health Concerns?
Any Current Medication
Registered GP Practice:
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How did you hear about us?
Word of Mouth
GP
Counsellor or other Health Professional
Email
Flyer / Poster
Internet / Social Media
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Terms & Conditions
By attending the Retreat, I understand that when undertaking any physical exercise (e.g. QiGong) or outdoor walking, the risk of injury is always present and cannot be eliminated. I voluntarily and knowingly recognise, accept and assume this risk.
Agree
Disagree
I have fully disclosed to the organisers any conditions that I have or may have prior to participating in this Half-Day Retreat. 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 CIC or the walk & workshop facilitators.
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Disagree
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Photography & Data Permissions
Thriving Communities and the workshop facilitators 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.
Agree
Disagree
I agree to be added to an email list to be kept informed of future Thriving Communities and Spirit of Nature programme events. I understand that my data will never be shared with a third party, and I can unsubscribe at any time.
Agree
Disagree
The data provided above will be stored and processed in line with GDPR guidelines in order that: the exercise, walk and workshop facilitators have 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 Esther Apoussidis at hello@thrivingcommunitiescic.org.
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Disagree
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Checkout
Please select the appropriate option. This event is only designed for adults aged 18+.
Select your payment choice:
By bank transfer to Thriving Communities CIC, Account No: 76487539, Sort Code 51-61-02 (as ref use Retreat). Please click Submit button and skip card payment checkout.
Card payment - complete checkout below and then click the Submit button.
Payment by Card
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Breathe & Energise Retreat - Standard Rate
Standard Rate
£
30.00
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Breathe & Energise Retreat - Premium Member Rate
Premium Member Rate (email hello@thrivingcommunitiescic.org if you wish to become a premium member; it's just £30 per year)
£
25.00
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Credit Card Details
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Card Expiration
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