8-week course Sign-up - Mindful Academy Solterreno

8-week MBSR Sign-up Application Form

Please fill out the form below to get started on your MBSR journey.

"*" indicates required fields

Name*

Email*

Address*

Phone*

Emergency Contact Phone*

Date of Birth*

Passport / ID Number*

Which 8-week course dates are you applying for?*

Please tell us a bit about yourself.*

Please tell us a little about yourself, including your current occupation.

Have you practised meditation before?*

Mental Health?*

Have you had any mental ill-health within the last few years, such as anxiety or depression? If yes please tell us about it here.

Taking Medication?*

If you are taking any medication at present, please say what it is and what it is for.

Life event in the last year?*

Have you had any disturbing life event in the last year, which may make the course difficult for you?

I have read and accept the Terms & Conditions.

I have read and accept the Privacy Policy.

I am happy to share my email with others in the same course to help communication within the group.

Comments

This field is for validation purposes and should be left unchanged.