BE. Meditation in Motion Student Registration Details

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Thank you for completing this form. It is confidential and any information provided is strictly for the use of Be.Meditation in Motion only.

Surname *

First Name *

Home Telephone No *

Mobile No *

Email address *

Your regular class *

Please tick the classes that are relevant to you.

Monday 10.00-11.30am

Monday 7.00-8.30pm

Tuesday 7.00-8.30pm

Thursday 10.30-12.00pm

Friday 10.00-11.30am

Thursday 6.00-7.30pm

Workshop only

Retreat

One-to-one

Required

Medical Discalimer *

The practice of Qigong and the meditative arts may carry risks. All materials covered in class are not intended as a substitute for the advice of your doctor, psychotherapist or other healthcare professional. If you have any physical, or any emotional, mental or medical conditions, please consult your health care provider regarding whether or not the exercises are appropriate for you. You should consult a professional before undertaking any movement, meditation, health or exercise program to reduce the chance of injury or any other harm that may result from pursuing or trying any techniques such as those discussed and practised in class, workshops or on retreats. Any physical or other distress experienced during or after any exercise should not be ignored and should be brought to the attention of your instructor and a healthcare professional. Please make your instructor aware of any medical condition you may feel could be of importance in relation to practising any Qigong, Breathing or Meditation. Thank you.

I confirm I have read and understood the Medical Disclaimer.

Required

General Important Information and FAQ's *

Class are £32.50pcm paid at the beginning of every month. All classes must be paid for in advance and are non-refundable in the event that the student is unable to attend.

Please ensure you arrive 10 minutes prior to class starting

It is best not to eat at least one hour before class

Please ensure ALL mobile phones are turned off

If you arrive late please respect that other students are 'settling-in', please wait for an opportune moment to come into class - quietly

If you cannot attend class please notify me by email or text 07977 114031. Long term absence may result in your place being offered to another waiting student as class numbers increase.

If you miss a class you are welcome to join any other class within the month to catch up

I try not to bug you with unnecessary emails. The information I do send is usually important and relevant. I also try and create a seasonal newsletter/mini-mag again with relevant information. Please take time out to read them, it is the best way to communicate important information to you.

Required

How did you find out about BE.Meditation in Motion *

Internet search - please detail below your search criteria i.e. qigong in norwich

Word of Mouth - please detail below who recommend you

The Orange Grove Clinic

Poster

Leaflet

Norwich Wellbeing Centre

Other:

Required

Your say? *

I am always seeking to provide the best possible service through teaching Qigong. Please add your confidential comments here if you like anything in particular or would like to see anything different? Thank you

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