Drama2Calmer-MBSR Registration Form
Course provider/teacher: Drama2Calmer Mindfulness – Cornelia Baumann

Venue Information: Online Live Via Zoom

Course: 8-week Mindfulness-based Stress Reduction Course MBSR

PLEASE NOTE that acceptance onto the 8-week course is dependent on completing this Registration Form and having an initial Induction Call via Zoom.

In accordance with the Good Practice guidelines, as outlined by the UK network for Mindfulness-based teachers, the registration process includes a brief induction talk between teacher and participant to determine suitability for the course and to give more detailed information about what the 8-week course entails (You can also book one of our FREE TASTER SESSIONS to find out more and combine that with the induction talk).

Registration information:

If you would like to proceed with the registration, please complete the form below as fully and accurately as possible. All information is used for assessment of participation suitability only and is not passed on, shared or disclosed to any third party. We will then contact you to arrange an induction call via zoom to discuss if the course is suitable for you at this point in your life, and to ensure that you are clear to what the course offers and demands.
By providing the below information and submitting the registration you agree for Drama2Calmer Mindfulness - Cornelia Baumann to store your information on their secure system and share it with the necessary team members to both administer and deliver appropriate teaching.
Terms & Conditions - We never share your information; however, we occasionally send news updates and information to delegates about our forthcoming courses, workshops and events. If you would rather not receive this information, please indicate that here by ticking NO
First name *
Surname *
Email *
Address *
Phone number *
Emergency Contact *
How did you find out about this course? *
Please answer the following questions so that we can work together safely
If you answer yes to any of the questions and/or have any areas of concern, please give as much details as possible. All information given is treated with the strictest confidentiality and will be discussed during the induction call via zoom.
Your physical health:
Do you have any current medical conditions. If so, please give details: *
Do you have any physical illness or other limitation that may make hearing, sitting, standing, walking or doing simple exercises difficult for you? *
Your mental health:
Have you had any mental health issues or concerns within the last few years, such as anxiety or depression? *
Have you ever received psychiatric or psychological treatment before? *
Have you ever made a suicide attempt? *
PLEASE NOTE – If you are currently receiving counselling, psychotherapy or any mental health treatment please tell your therapist that you are undertaking the course.
Sometimes things happen to people that are extremely upsetting - like being in a life-threatening situation; being physically assaulted, seeing another person attacked or hurt, or hearing about something horrible that has happened to someone you are close to. At anytime during your life, have any of these kinds of things happened to you? *
Has alcohol or drug use (including over-use of prescribed medication) ever caused problems for you? *
Please give details of any previous mindfulness courses, training or retreats you have attended or plan to attend: *
Please indicate briefly what you hope to get from this course: *
Any other information you would like to pass onto your teacher in connection with this registration: *
INDUCTION ZOOM CALLS - Please indicate here or in an email when might be a good time for you to have the induction call via zoom (around 20 mins)
AM
PM
Monday
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Sunday
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