Healing Circle Registration Form

Healing Circle

Please complete the following form to register for the Healing Circle - a successful collaboration designed 3-week programme hosted and facilitated by Willow Brook Healing & Thriving Communities CIC. The programme take place Sundays 10am-12noon (12th, 19th & 26th January 2025) at Fleur de Lys Community Centre (37 High Street, Fleur de Lis, Blackwood NP12 3UE). If you have any questions about this, please email Mel at hello@thrivingcommunitiescic.org or message her on 07590 592902.
Name*

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

Terms & Conditions
By attending the Healing Circle, I understand that when undertaking any physical exercise (e.g. QiGong, walking), 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 organisers any conditions that I have or may have prior to participating in this Healing Circle. 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 Willow Brook Healing.

AgreeDisagree

Photography & Data Permissions
Thriving Communities and Willow Brook Healing 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 similar events. 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 the 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.

AgreeDisagree

Checkout

Please select the appropriate option based on the dates you selected above. Cost is £12 per week or £40 for the entire 4-week series. Therefore, if you are paying for 1 date only, pay £12; if you selected 2 dates, pay £24; if you selected 3 dates, pay £36.
Healing Circle Pricing
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Healing Circle - 3-week courseSaves you £6 if booking for all 3 sessions
£30.00 Quantity

Healing Circle - per week ratePlease add appropriate quantity if choosing between 1 and 2 weekly sessions. If you are attending all 3, please choose the above 3-week course option (where you save £6 for attending all 3).
£12.00 Quantity

Total

£0.00
Choose your payment method:

By bank transfer to Thriving Communities CIC, Account No: 76487539, Sort Code 51-61-02 (as ref use Circle). Please select and click Submit button.Cash payment (pay on arrival) - please select and click Submit button.
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Healing Circle