Eight-week mindfulness course for the public

Eight-week mindfulness course for the public

All courses are online and are nine weeks in total, including the orientation session. Please find the list of course date options at the bottom of this form. The course costs £250 to attend (or £225 supported rate; £275 supporter rate).
To help us support you as best we can, please complete the following questions. Most fields are mandatory - please do leave as much detail as you can and state if you would like to arrange to speak with the course facilitator privately if preferred. The form will remain confidential to the course organiser and facilitator.

All enquiries to spft.smc@nhs.net
- Application form name
  This information is for reference only
- Full name
  
  First NameLast Name
- Job role (if relevant)
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Post CodeCountry
- Email
  example@example.com
- Please provide a second work or personal email if you'd like course information sent to both addresses:
  example@example.com
- Mobile number
  Example 07770 123456Format: 00000-000000.
- Best way to contact you if you do not attend a session of the course? Please give a number or email.
- GP details
  
  In the unlikely event that we need to contact your GP for your own health and safety or the safety of others, please provide details below.
- GP/Practice Name
- GP Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- GP Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- So we can understand how to best let people know about our work, please tell us where you heard about this training. Please tick all that apply.
  
  Other
- Why do you want to attend this course?
- The course involves attending eight two-hour group sessions (and an initial orientation session) and suggested home practice of between 20-40 minutes a day between sessions. Having checked all the dates and times of your chosen course (options listed below) can you foresee any difficulties that you may have with doing this?
- If ‘yes’, please explain
- The course asks people to make gentle movements. These can usually be adapted to meet people’s needs. If you have any physical mobility concerns or queries please provide details below.
- If you have any additional needs or learning styles that would support your inclusion in this course, please could you let us know below.
- Is there anything else it would be helpful for us to know that might affect how you get on in the group sessions? (For example, it would be important to mention any mental health issues, any recent, significant stress or life events, and any concerns you might have about being in a group). Even if you do not provide full detail here, it is important that you make the facilitator aware if these issues exist so they can support you should they manifest in the process of doing the group sessions.
- In order to support their continuing professional development and ongoing professional registration, the group facilitator may wish to record some sessions of the mindfulness group. These recordings would be stored securely, only shared with the facilitator's supervisor and deleted after use in supervision. Please confirm whether you are in principle happy for this to occur (if all participants are in principle happy with this then we'll ask everyone to complete a more detailed consent to recording form).
- Are you interested in going on to train to teach mindfulness with us?
- Would you like to be added to the Sussex Mindfulness Centre email list to stay aware of our future events, groups and training? (We will not pass your details on to anyone else outside of SMC.)
- Please let us know which course you would like to attend by placing it in the 'selected' right hand column. (Simply click on your chosen course to move it back and forth between the columns.)
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Eight-week mindfulness course for the public

GP details