Mindful Me Program Registration

Mindful Me Program Registration

Mindful Buddies and The Compassionate Leader
Name of Educator*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name of School or Educational Group*
Typically, we run 90-minute sessions for 3 separate groups throughout the day. Please tell us how you will form your groups.
teacher's name has number of students in grade(s) enter grade(s)
teacher's name has number of students in grade(s) enter grade(s)
teacher's name has number of students in grade(s) enter grade(s)
What type of day are you on?*

BalancedTraditionalN/A
Please indicate the start and end time for your day.*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Do you have a preferred date?

MonthDayYear
Location for Sessions*

Street Address

Street Address Line 2

City/TownState / Province

Preference for Set-Up: Indoors (Classroom, Gymnasiums or Activity Room) or Outdoors
Please describe any mindfulness training the students have received.
Do you have your own mindfulness practice? If so, please describe.
The sessions can be differentiated to suit the immediate needs of your students. Please indicate if there are any areas that you may be focusing on and would like to highlight in addition to the mindfulness training provided in the programs.
Do you have any questions about the program(s) or their delivery?
Are you interested in further mindfulness training or events? (check all that apply)

Expanding your personal practiceAdult mindfulness trainingMindfulness activities for the neurodiverse child (ADHD, ADD, FASD, ODD, ETC)Integrating mindfulness into other subject areas (ex: mindful math activities)Parent/School mindfulness presentation
Please indicate which areas of training you are interested in receiving more information (check all that apply)

Breathing exercisesMindful movementEmotional regulationNature-based mindfulness activitiesSensory mindfulness activitiesRelaxation exercisesBrain-based activitiesMindful artMindful journalingSetting up a mindful classroomCreating a mindful school communityMindfulness resources
Would you like to be a part of our Mindful Community email list?

YesNot at this time
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