.b Foundations Hub Membership Application

Full name*

Email address for membership communication*

Country*

Region*

Employment:

Your Profession*

Your Employer*

Your Employer's Postcode*

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
Other (please specify)
I am self-employed

Please specify*

Name of school or place of work*

Postcode of school or place of work*

Your .b Foundations course details:

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

I have successfully completed an 8-week .b Foundations course.

Name of your .b Foundations instructor*

Contact details for your .b Foundations instructor*

Date you completed your 8-week .b Foundations course*

Where did you attend your 8-week .b Foundations course?*

Name of school/ setting and location.

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 Sits.

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, SIT groups and training with MiSP in the future.
I’d prefer not to be contacted

Please fill in the form below if you have completed a .b Foundations course at your school and would like membership of our Hub, available from just £25 a year:

MiSP .b Foundations Participant Membership Application

Employment:

Your .b Foundations course details:

Other Information: