Participant registration for mindfulness for birth programme
This form is to be used by Participants wishing to register for an in- person or online Programmes facilitated by Lisa Kennedy of Calmpaths.ie

DATA PROTECTION NOTIFICATION
Your personal data as provided on this form will be used for the purposes to register for Calmpaths programmes in Mindfulness and Compassion based programmes only.
The Data Controller for the personal data provided on this form is Calmpaths.ie . The Clampaths.ie Data Protection Officer can be contacted by email at dataprotection@calmpaths.ie - if you have any questions or queries in relation to your personal data.
Your personal data will be stored securely for the duration of the programme but not passed on to a third party and will be safely destroyed after the programme.
Any information you provide will be treated confidentially.
Info on your rights: www.gdprandyou.ie. If you would like to make a complaint or report a breach in relation to your personal data, you can do so via the Data Protection Commission's website at www.dataprotection.ie, or by email to info@dataprotection.ie.

I have read the above registration form and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above *
Required
Name *
Address *
Post code *
Phone contact *
Date of birth *
MM
/
DD
/
YYYY
Email address: *
Participants need to have reached 14+ to register for theses classes. Please note your estimated day of delivery? *
Do you have any of the following pregnancy complications or concerns? *
Required
Do you have any other medical condition that it would be helpful for me to know about ? *
If yes, please contact Lisa@calmpaths.ie directly to see how your individual needs can be met, before commencing on programme or event
Contact details of next of kin ( in case of emergency) Please include their name and phone number *in person course only
How did you hear about this mindfulness for birth programme ?
Signed *
Date *
MM
/
DD
/
YYYY
Submit
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