New Client Registration Form
Client Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
Town/city
County
Postal code
Emergency contact phone no.
*
-
Area Code
Phone Number
Emergency contact name
*
E-mail
*
example@example.com
How did you hear about us?
Please Select
Social media
Word of mouth
Magazine
Other
Would you like to be added to Melbeing’s WhatsApp group for class/info.
Yes
No
Phone Number
-
Area Code
Phone Number
Medical injuries/allergies/conditions
*
Do you carry epi pen/inhaler other medical prescriptions
*
What classes are you attending/interested in
*
Air Water Resonance
Harmonic Sound Healing
Sound Healing for Teachers
1:1 bespoke sessions
80s Dance Fit
Teen Well-being age 13-17
Important:Please read disclaimer. Melbeing classes and sessions support general wellbeing through movement, breath, meditation, and sound practices. They are not a substitute for medical or psychological care. Please consult a qualified healthcare professional if you have any health conditions that may affect your participation✔ By ticking this box, you agree to take part in this class. You confirm that you are responsible for your own health and have disclosed any medical conditions, past or present, that may affect your participation or put you at risk of injury. You understand that you participate at your own risk and take full responsibility for your physical, mental, and emotional well-being during and after the class.You confirm that you are fit and well on the day of your participation. Please note that all payments are non-refundable except in the event of cancellation by the practitioner. 24 hour notice for 1:1 bookings must be given to reschedule
*
I agree
Signature
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Date
*
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