Mindfulness Online Course

Age.*
Date (Please only select 1)*
Date of Diagnosis (If applicable)
  • Less than 1 year
  • Less than 2 years
  • Less than 3 years
  • Less than 4 years
  • Greater than 5 years
Gender.*
  • Male
  • Female
Have you ever attended a similar course?*
  • Yes
  • No

Contact Information

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Email*
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Phone*
Health issues

General Data Protection Regulation

By choosing my preferences below, I understand that my data and information can be held, accessed and processed by Rainbow Valley for the purposes of evaluation and research. I further understand that all personal data or information I provide to Rainbow Valley will be kept confidential and that no identifiable personal data will be published, presented or shared with a third party, or made public, without my express consent. Information held and processed by Rainbow Valley is in accordance with the General Data Protection Regulation requirements. We will not give out data about you to third parties for marketing purposes. Your details will only be used by Rainbow Valley. We would also like to keep you up-to-date with our upcoming events and courses. Please choose your preferred method of communication below. We will only use the emergency contact details if required. We will not contact them with news or events. Please note that we need to store your information in order to contact you for the course. 

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You can opt out of our database at any time by emailing info@rainbowvalley.org.uk.

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By submitting this form you are confirming that you have read and understood Rainbow Valley’s terms and conditions and that the information you have provided is accurate.

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