Distance Learning Mindfulness Course – Application Form

Booking Form for Online Mindfulness Courses

For fees and further details, go to Online Mindfulness Courses. If you have any further queries about the distance learning programme, please contact us.

1. Please give us some details about yourself.

Name

Your Email

For the one-to-one sessions, I prefer using

Skype Name

Phone Number (including country code)

How did you hear about this course?

What is your main reason for participating in
the mindfulness course?

Any previous experience with mindfulness
meditation or any other type of meditation?

Do you have any physical, medical or mental
health condition that we should be aware of?
(Answering yes does not necessarily exclude
you from attending the course.)

Are there any particular stressful elements
in your life at present? (Significant changes in
your circumstances, e.g. relationships, work,
where you live, health).

Are you aware that participation on the course
requires approximately 45 minutes of practice
a day, for the duration of the eight weeks?

2. PLEASE NOTE:

Mindfulness-based Stress Reduction (MBSR) has been found to be effective in promoting health and wellbeing for individuals facing a wide variety of challenges. However, MBSR may not be an appropriate choice for you at this time.
This may be the case if you are dealing with:

  • An acute medical condition requiring frequent intervention or treatment.
  • Substance abuse or dependence (currently or within the past year).
  • Psychological issues including: suicidality, psychosis, trauma, severe depression or other major psychiatric diagnosis.

MBSR is not psychotherapy, and is not a substitute for mental health counselling, medical care or substance abuse treatment. You will have an opportunity to talk, one on one, with a course instructor prior to signing up for the course and it is important that you discuss any questions or concerns you have regarding your specific situation. We realise the personal nature of this information and we hold your responses in confidence. Please note that final decisions about participation in the course will be made by the course teachers.

Confirmation:

I have read the above information and understand that my application will be considered only after paying a refundable deposit of £50 (see payment instructions below). I am aware that benefiting fully from the course requires regular attendance on the sessions and regular home practice.

Please tick the box


3. Please Pay Your Deposit

After submitting your booking form, please use the secure Paypal payment button below to pay a deposit of £50 (see how much it is in your currency). Your booking will be considered complete upon receiving your deposit.

Pay Securely With Paypal (£50)

4. Please book your Free Initial Session

Book online mindfulness training
 
 

What happens next?

After receiving your application form, deposit payment and the booking of your initial session, we will review the information and then contact you at the time you indicated in the booking form. Attending an initial session does not mean you are obliged to start with the course and you will be able to decide whether you want to work with us or not. At that point, if you don’t feel that you want to commit yourself, we will return your deposit payment.

If you decide to go ahead, we will agree on a mutually suitable times schedule for the regular sessions, you will pay the remaining balance and we are ready to start.

Any further questions?

Please get in touch.