MiSP One Day Retreat Application - Mindfulness in Schools Project

Please select the MiSP One Day Retreat you are applying for*

Please select a Retreat from the drop down menu before proceeding with your application.

I confirm I have read and agree to the Terms & Conditions.*

Yes

Are you a member of the MiSP Hub?*

Yes
No

Please complete the application form which is in the Hub for your free place on the Retreat Day. If your membership has expired, please do consider renewing to take advantage of this offer. Membership starts from £27 per year. Otherwise, please continue with this application for a place for £50.

Full Name*

Email address*

Please check that this is entered correctly.

House number or name*

Street*

Town or city*

County or state*

Postcode*

Country*

Region*

Home telephone number (please include country code)*

Mobile telephone number (please include country code)*

Emergency Contact name and number whilst on the Retreat:

Name*

Number (Landline)*

Number (Mobile)*

Your Profession*

Your Employer*

Is your employer*

A maintained school (incl. grammar school) or academy chain in the UK
An independent school in the UK
A council, LEA or other governmental body
A non-UK school or other international educational body
Bedfordshire Schools Trust (BEST)
Other (please specify)
I am self-employed

Please specify*

Name of school or place of work:*

Postcode of school or place of work:*

Please select which 8-week mindfulness course you attended*

.b Foundations
.begin
MBSR
MBCT
Finding Peace In A Frantic World
Breathworks
MBLC
Mindfulness For Life
The Present For Adults

Please specify the date you completed your 8-week course*

What was the name of your 8-week course teacher?*

8-week course Teacher contact details*

I confirm that I practise mindfulness for at least 20 minutes a day, 5 out of 7 days a week.*

I confirm a personal practice

Have you ever attended a retreat before?*

Yes
No

How long was the retreat you attended?*

1 day
2-5 days
6-10 days
Longer than 10 days

Please select all that apply.

How frequently do you attend retreats?*

This is my first one
I have been to one or two before
I attend retreats regularly
I attend retreats more than once a year

Please confirm you are over 18 years of age*

I confirm that I am over 18 years of age

Please confirm your level of English*

I confirm that I am able to speak and understand English to an Upper Intermediate Level, i.e. I am able to interact fluently with native speakers, communicate effectively and understand everyday language without the aid of an interpreter.

Additional Questions

A member of the MiSP team may contact you to discuss your application to ensure this is the right time for you to be attending a Retreat.

Have you attended a MiSP Retreat before?*

No - I have not attended a MiSP Retreat before
Yes - My physical/mental health status HAS NOT changed from previous applications
Yes - My physical/mental health status HAS changed from previous applications

Please detail the changes to physical/mental health below*

QUESTION 1: Do you have any physical illness (including allergies) or other limitation that may make sitting, standing, walking or doing simple mindfulness practices difficult for you? If yes, please provide more details below.*

Yes
No

Please explain*

QUESTION 2: Are you currently taking any medication which could have an impact on your participation on the retreat? If yes, please provide more details below.*

Yes
No

Please explain*

QUESTION 3: Do you have any difficulty with sight or hearing that may affect your participation in the Retreat? If yes, please tell us about it.*

Yes
No

Please explain*

QUESTION 4: Have you ever experienced any mental ill health? In particular, anything that has led to you having support from a doctor or other medical professional? If yes, please tell us about it including any relevant dates.*

Yes
No

Please explain*

QUESTIONS 5: Are there any aspects of your life that you feel may affect your participation in, and experience of, the retreat, e.g. bereavement, health issues, trauma (recent or in your past) etc.? This might include major life events coming up in the near future e.g. house move, getting married, new job, birth of a child etc.*

Yes
No

Please explain*

QUESTION 6: Is there anything else you think it would be helpful for us to be aware of that may affect your participation in the Retreat?*

Yes
No

Please explain*

Please confirm that you understand that this retreat is not a substitute for any medical treatment you might need.*

I understand that the MiSP Retreat is not a substitute for any medical treatment I might need. I agree that, if I have, or have had in the past, symptoms of physical or mental ill-health, I have consulted with my doctor and/or other healthcare professionals that it is safe and appropriate for me to attend this retreat. If you wish to discuss any concerns you might have about the Retreat in this respect, please contact enquiries@mindfulnessinschools.org

We would like you to get the very most out of this online Retreat. Please be prepared as follows.

I understand it is my responsibility to:*

Use the Zoom test call function to test my camera, microphone and sound prior to the course.

I understand it is my responsibility to:*

Ensure I can attend the Retreat from a room with a closed door where I will not be interrupted. If I have no alternative but to attend the course from my workplace, I will ensure that my colleagues understand that I will not be available for work-related tasks or responsibilities such as supervising students or attending meetings.

I understand it is my responsibility to:*

Use a computer which is resting on a hard surface (rather than using a handheld device for the training).

I understand it is my responsibility to:*

Bring a commitment to my practice and a willingness to participate in this Retreat.

Where did you hear about this Retreat?*

Please state*

Please enter the search term used*

We’d love to stay in touch.*

I’d like to be kept up to date so I can find out about what’s on offer in the HUB, MiSP news and events, practice groups and training with MiSP in the future.
I’d prefer not to be contacted

Program Cost

Price:

Payment Method*

American Express

Discover

MasterCard

Visa

Maestro

Card Number Expiration Date Security Code Cardholder Name

Emergency Contact name and number whilst on the Retreat:

Additional Questions

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