Hub Membership Application for 8-week courses

Full name*

Email address for membership communication*

Country*

Region*

Your 8-week course details:

I confirm that I have successfully completed an approved 8-week course.*

I have successfully completed an approved 8-week course.

Which approved 8-week course have you completed?*

Date you completed your 8-week course*

Name of your 8-week course instructor*

Contact details for your 8-week course instructor*

Employment:

Your Profession*

Is your employer or school*

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
Other (please specify)
I am self-employed

Please specify*

Your Employer or School*

Please type "Not applicable" if you are not currently in employment

Your Employer or School's Postcode

Other Information:

A member of the MiSP team may contact you to discuss the information you provide below. Please note this will be treated in the strictest confidence.

Do you have any physical illness (including allergies) or other issues that may make sitting, standing, walking or doing simple mindfulness practices difficult for you? If yes, please tell us about it.*

Yes
No

Please explain*

Are you currently taking any medication which could have an impact on your participation in Hub Sits or Retreats? If yes, please provide more details below.*

Yes
No

Please explain*

To my knowledge, there are no personal mental health issues, trauma or major life events that are likely to affect my participating in Hub Sits or Retreats.*

Agree - there are NO personal mental health issues which might affect my participation.
Disagree - there are mental health issues which might affect my participation.
Not Sure

Please explain*

If there anything else you think it would be helpful for us to be aware of, please feel free to use the box below to outline this.

Consent*

I agree to inform Mindfulness in Schools Project if my personal circumstances or health changes and will therefore potentially impact on my participation in Hub Practice Groups or Retreats.

Please confirm you are over 18 years of age*

I confirm that I am over 18 years of age

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

Please fill in the form below if you would like Hub membership and have completed one of the following:

MiSP 8-week courses Hub Membership Application

Your 8-week course details:

Employment:

Other Information:

Please fill in the form below if you would like Hub membership and have completed one of the following:

MiSP 8-week courses Hub Membership Application

Your 8-week course details:

Employment:

Other Information:

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