Healing Circle Registration Form

Healing Circle: Embrace, Transform & Thrive

Please complete the following form to register for the Healing Circle - a unique collaborative 4-week programme hosted and facilitated by Willow Brook Healing & Thriving Communities CIC. The programme take place Sundays 10am-12noon (17th & 24th November, 1st & 8th December 2024) 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*
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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.

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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.

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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.

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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.

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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 - 4-week courseSaves you £8 if booking for all 4 sessions
£40.00 Quantity

Healing Circle - per week ratePlease add appropriate quantity if choosing between 1 and 3 weekly sessions. If you are attending all 4, please choose the above 4-week course option (where you save £8 for attending all 4).
£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: Embrace, Transform & Thrive