Mindfulness & Meditation Course 2019

PLEASE NOTE THAT YOU MUST HAVE COMPLETED  OUR 7 STEPS TO HEALTH COURSE PRIOR TO APPLYING FOR OUR MINDFULNESS AND MEDITATION COURSE.

Please note that only those with a cancer diagnosis must complete an online booking form. Terms and conditions apply. These can be found on the website. We advise you read these prior to completing this form. A copy of our terms and conditions will also be sent in receipt of your application.  

Confirmation*
  • I have had a cancer diagnosis and have attended a 7 Steps to Health Course
Age.*
Preferred Date *
  • 22nd-23rd April 2019
  • 4th-5th June 2019
  • 30th Sept - 1st Oct 2019
Date of Diagnosis
  • 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

Name of supporter (if applicable). Please note, you will be required to share a room with your supporter.
Country
State / Province*
Address
City
Email*
Confirm Email*
Phone*
Health issues
Dietery requirements. Any dietry requirements of supporter to be included in the comments section at the bottom.
Special requirements eg ground floor bedroom?

Emergency Contact

Name *
Tel:*
Mobile:

PLEASE NOTE THAT IF YOUR SUPPORTERS EMERGENCY CONTACT IS DIFFERENT FROM THIS, PLEASE ADD TO THE COMMENTS SECTION.

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 will require at least one method of communication for our course information.

PLEASE TICK
  • I agree to above

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

Terms and Conditions

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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