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
Couples Private Sound Healing
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 signing below, 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/transferable except in the event of cancellation, the practitioner may transfer you to another date. 24 hour notice for 1:1 bookings or private couples sound healing sessions, must be given to reschedule
*
I agree to pictures and videos taken in any Melbeing, session to be used for adverts and social media purposes only .
Signature
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Date
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