Nature Walk & Qigong Registration – The Conscious Cabin

Full Name *

Email Address *

Mobile Phone Number *

Emergency Contact – Full Name *

Emergency Contact – Mobile Phone Number *

Do you have any injuries, medical conditions or limitations that might affect your participation? *

If yes, please describe your injuries / conditions

Are you currently any doctor, physiotherapist or healthcare provider for any injury or condition?

If yes, please provide details;

Do you have any mental health conditions or considerations (e.g. anxiety, depression) that might affect your participation? (Optional)

Are you taking any medications we should be aware of that could affect your participation? (Optional)

Would you like to speak to me directly before coming? (Optional)

If ticked, I’ll be in touch to arrange a convenient time to discuss any questions, concerns, or additional information.

I confirm that I have answered these questions honestly and will notify the teacher of any changes to my health, physical or mental. I understand participation is at my own risk

I consent to my information being used solely to register me for this class and to ensure my safety during participation.