Taking it Further Registration
Event Timing: From 2 Oct 2021 to 11 Dec 2021, Alternate Sat [9am to 1pm]
Event Address: SCWO @ 96 Waterloo St, Singapore 187967
Full name (To be shown on certificate) *
Email *
Contact number *
Gender *
Age *
Occupation / Designation *
Please state the type of 8-week mindfulness program that you have completed. E.g. MBCT, MBSR etc. *
Please state the mindfulness teacher's name, the year and country in which you completed the program. *
Emergency contact - Name *
Emergency contact - Relationship *
Emergency contact - Number *
Do you have any limitation on your physical mobility that might make sitting, standing, walking or physical activities difficult for you? If yes, please elaborate. *
Are there any present circumstances which might be placing you under exceptional stress, such as depression, anxiety, stressful life changes (e.g. bereavement, loss of home, job etc.)? If yes, please elaborate. *
Are you currently receiving any form of treatment (e.g. psychological or medical treatment)? If yes, please elaborate. *
Why do you want to attend the programme (e.g. physical health, mental wellness, stress, self-development etc.)? What do you hope to gain from the programme? *
How did you find out about this program? (E.g. Word of mouth Referral, social media etc, if by referral, please indicate name of referee.) *
I understand that the registration for the course will only be confirmed after this submission has been reviewed by the facilitators and on payment of the course fees. (Note: The organisers will be in touch shortly with more details after this form is submitted.) *
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