Alite Mind Class Enrolment Form

Firstly, I would like to welcome everyone to Alite Mind - Meditation and Mindfulness. Could you please fill in the following class enrolment form. This information is strictly confidential but is critically important for me to understand so I can best support and facilitate all meditation practices.

Please answer all items, so I can best support you during these sessions. Thank you.

"*" indicates required fields

Participant's name*

Date of birth*

Email*

Phone / Mobile*

Occupation*

Address*

Emergency contact name*

Emergency contact phone*

Questions

Have you practiced meditation/mindfulness before? Please list the dates and length of any prior experiences.*

What are your meditation goals?*

What current stressors are you facing?*

Are there any experiences you’ve had in the past that are still causing you stress?*

Do you experience chronic conditions such as pain?*

Are you currently seeing a therapist or counsellor and if so do they know that you will be joining in on these meditation sessions?*

Are there any other health concerns that you think I should be aware of?*

Is there anything else you would like me to know at this time?

Session booking: Upon booking your attendance you will be invoiced for the selected session pass. If for any reason you cannot attend, please read the cancellation policy. If you simply do not show up, then the session fee may be forfeited.

Refund policy: I am confident that you will find my courses and guided meditation sessions valuable and empowering and that you will benefit from your own self-exploration. Fees will be refunded after one class if you decide the course or practice is not for you. If purchasing a session pack after the second class, fees are not refundable.

Cancellations: Meditation classes and groups sessions require pre-payment. It is preferred that a 24-hour notice of cancellations is given, or a 50% late cancellation fee may apply. Personal Information Quality: Any personal information you provide will be used for the reason for which you have provided it, e.g. request a quote for my services or for invoicing, unless you consent otherwise. I may also from time-to-time email you about an event or new feature that I think might be of interest. If you do not wish to receive such emails, hit the reply button and type “remove” in the subject field of the email. I will not disclose your personal information to third parties unless you consent or in other circumstances where such disclosure is required or authorised by law. Contracts I enter with other parties for the provision of services may require me to disclose your personal information to them. In those cases, my contracts require other parties providing services to Alite Mind to observe the terms of this Privacy Statement.

Thank you so much for your interest and involvement with these meditation sessions. I appreciate you completing this form. Should you ever have any questions, please feel free to contact me.

Warm Regards,
Natalie Michels
Counsellor, specialist Mindfulness and Meditation practitioner

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