Free Take Back Your Life Mindfulness Course
For Salford residents who are looking to get back into work, training or volunteering, and are managing any kind of health condition, including physical conditions, pain or chronic illness, stress and anxiety. We also have a couple of places for Trafford residents on this free three-week course.
Name
*
First Name
Last Name
OpenCRM Event
Contact email address
*
example@example.com
Contact telephone number
*
-
Area Code
Phone Number
Your postcode
*
The three week course will run from Monday 3rd February to Monday 17th February, 2024. It will take place from 10am - 1pm each week at Langworthy Cornerstone, 451 Liverpool Street, Salford M6 5QQ. Please tick the boxes that apply to you:
*
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 looking to get back into work, training or volunteering.
I am available for the three weeks of the Take Back Your Life course, and can attend each Monday from 10am - 1pm.
To be able to join the free 3-week course, you first need to attend a free 90-minute Introductory Session, where you'll be able to meet the trainer, hear about the course, and experience a taste of mindfulness. To book onto the Introductory Session at St John's Church Hall on Thursday 17th October, please tick below:
*
I'd like to attend the 90-minute Introduction to Mindfulness session on Thursday 17th October, 10 - 11.30am, at St John’s Church Hall, Irlam’s O’ The Height / Pendlebury, Bolton Rd M27 8XS.
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.
*
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
*
WhatsApp
Email
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
Is there anything else you would like us to know about you?
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?
*
Age
*
Ethnicity
*
Please Select
Asian / Asian British (including Chinese)
Black / African / Caribbean / Black British
Mixed / Multiple ethnic groups
White (including White British, Irish, Gypsy or Irish Traveller)
Other
Prefer not to say
Gender
*
Please Select
Female
Male
Non-binary/other
Prefer not to say
Do you have a disability?
*
Yes
No
Prefer not to say
Do you have a long-term physical health condition
*
Yes
No
Prefer not to say
Are you a carer?
*
Yes
No
Safeguarding contact info
Emergency Contact Name (e.g. next of kin)
*
Emergency Contact Number
*
-
Area Code
Phone Number
Name of GP Surgery
*
Please note that we will only contact your GP if you report any risk to yourself or others
Privacy & Cookies Policy
Download
Privacy and Cookies Policy
Submit
Should be Empty: