BELIEVE ENERGY I AM IMPORTANT WORKSHOP BOOKING FORM
PLEASE COMPLETE THE FORM
Email address *
Child's Full Name: *
Your answer
Age *
Your answer
Date of Birth *
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Date of Workshop *
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Why are you booking your child onto the workshop?
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Special Requirements/Needs
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Details of any conditions that might possibly affects child's performance or safety during the session?
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Child's School
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Where did you hear about us?
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Parent's Name *
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Email *
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Address *
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Phone number *
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Emergency Contact Name *
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Emergency Contact Number *
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Payment: £35 Children's workshop; £30 Refresher workshop (Internet Banking Preferred Method, Please bring proof of payment) *
Parents/Guardian's Statement (Under 18)
I acknowledged receipt of the information supplied regarding the sessions run by Believe Energy and consent to the participation of my child, named above. I understand that a blend of techniques will be used throughout the workshop including mindfulness, life coaching skills, reiki techniques, positive energy techniques, focus on gratitude in relationships, meditation, positive affirmation, vision boards and journals and am happy for my child to cooperate and use these techniques. I understand there are no side effects and this is a non-intrusive workshop. I understand that photography may be taken to use by Believe Energy on their website/social media or in promotional material. I undertake to inform Believe Energy in the event of any changes in my child's fitness prior to or during the session. I have provided Believe Energy with all information of any conditions/allergies/issues which my child may have during the workshop. I understand that I am fully responsible for my child’s overall condition/allergies/issues/health/safety/well-being despite my child being at the Believe Energy Workshop. I give the Believe Energy Team permission to administer first responses first aid on my child and that Believe Energy will contact me about any incident, however minor. I understand Believe Energy will not make any major medical decisions on my behalf and will only follow advice given by myself or a trained medical professional. I understand I will be contactable on the above numbers throughout the duration of the workshop so in the event of an issue, Believe Energy can contact me immediately. I am happy for my child to have a drink of juice/water and a biscuit provided by the Believe Energy Team or I have provided a suitable alternative for my child. I understand that I am fully responsible for my child’s overall behaviour/outcomes/consequences and that I can stay on the premises, in another room so not as to distract my child, to ensure this. I have ensured my child understands that it is important for his/her safety and for the safety of others in the session that any rules and any instructions given by the Believe Energy staff in charge, are obeyed. I understand that by submitting this form it does not guarantee my child a place at the workshop. An email confirmation will be sent to the email address above to confirm my child's place at the workshop stating what is required and where the workshop is located, this is due to children safeguarding and number restriction. *
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Print name in full *
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Relationship to child *
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Date *
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A copy of your responses will be emailed to the address you provided.
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