FREE Online ‘Take Back Your Life’ Mindfulness Courses
For residents of the Boroughs of Salford and Trafford, who are not in paid work, and are managing any kind of health condition, including physical conditions, pain or chronic illness, stress and anxiety. These are free online mindfulness courses and will take place on Zoom - an easy-to-use online platform that we can help you get set up on. For more info before booking - call Karen (Breathworks) - 0161 674 9256
Name
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First Name
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OpenCRM Event
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example@example.com
Contact telephone number
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Area Code
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Please tick the boxes that apply to you.
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I am a Salford resident and would like to learn mindfulness as a way to help manage a health condition
I am a Trafford resident and would like to learn mindfulness as a way to help manage a health condition
I am not in paid work. May be interested in getting back into work, training or volunteering
I would like to register for the Take Back Your Life six-week Mindfulness course, which will take place online via Zoom. Tick below to register:
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Monday 2nd December to Monday 13th January, 2pm -4pm each week. **N.B: there will be NO SESSION on 30th Dec, between Christmas and New Year**
What health condition do you have that have brought you to this course? Include any physical conditions, pain or chronic illness, and also mental health conditions, such as stress and anxiety. This would be useful background information for the course leader, and will be kept confidential.
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Our course leader may get in touch before the course to discuss any support you may need, please indicate if you are happy to be contacted.
Yes, I'm happy to be contacted
No, I'd rather not be contacted
Do you have any access or communication requirements which need to be met in order for you to engage fully, for example, support with a sensory impairment, such as hearing loss. If so, please give details.
Please tick if you have access to, and can use:
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Any other comments?
Reporting and demographic information
To help us ensure the service is accessible to everyone in the community.
How did you hear about the course?
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Age
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Asian / Asian British (including Chinese)
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Mixed / Multiple ethnic groups
White (including White British, Irish, Gypsy or Irish Traveller)
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Female
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Do you have a disability?
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Do you have a long-term physical health condition
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Yes
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Are you a carer?
Yes
No
Safeguarding contact info
Emergency Contact Name (e.g. next of kin)
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Emergency Contact Number
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Name of GP Surgery
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Please note that we will only contact your GP if you report any risk to yourself or others
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