Mindfulness Outdoors Registration

Thank you so much for signing up for this Mindfulness Outdoors Experience! I am delighted to offer different ways we can come together to practice mindfulness for the benefit of our own personal health and our collective community health.

Please note we will meet outdoors and weather is outside of our control. We will cancel in the event of winds forecast >30mph. Come prepared to stay as warm and dry as possible for the duration of the event. Footwear that is waterproof and suitable for uneven ground is also advised.

The email that accompanied details of this form confirmed the meeting place, suggested backpack list and a reminder about the requirements to attend on the day.

All information on this form is received in strict confidence and held according to GDPR regulations (2016).

Thank you and I look forward to sharing this experience together.

Please direct all questions to Sheena

sheena@discoveringmindfulness.ie | 087 6816635

Your Detail*

Name Contact Email

Phone Number

Please enter a valid phone number.

Confirm Date - Time - Place you will attend*

What draws you to this event?

Do you have any mobility or other needs that are important for the organisers to know?*

In case of Emergency

Please offer the name and contact number of someone who can be contacted on your behalf in the event of an emergency.

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Waiver

In signing and submitting this form, I hereby retain Sheena Burke as my guide for the Mindfulness Outdoor Experience and in so doing, I waive release and forever discharge Sheena Burke and the host venue from any and all responsibilities or liability for injuries, loss or damage resulting from my participation in these events.

Acknowledgement

In participating in this course, I hereby agree to and accept full responsibility for performing only those activities and moments that support and do not jeopardise my health and well-being. This includes dressing appropriately for the weather and terrain, bringing essential personal items such as drinks, snacks, medicine and hygiene products (i.e. hand-sanitiser/mask).

I understand that taking part in the activities of this event and being outdoors may carry a risk of harm as does all activity. I am voluntarily participating in this activity with full awareness of the risks involved. I understand that Sheena Burke is providing training, coaching, feedback and support in assisting me to become aware of my body’s inner wisdom. My role at all times is to be awake to the message my body is sending me and to stop any activity or movement that may cause pain.

I hereby declare myself to be physically sound and suffering from no condition, impairment, disease or other illness or symptom of illness that would prevent my participation in this activity at this time. I agree to consult my General Practitioner about any concern I have about a state of illness, dysfunction or pain and to advise Sheena Burke about such concerns.

I understand that I take responsibility for my self-care during this session and in abiding by safety protocols of hand hygiene, physical distancing and coughing/sneezing etiquette. This includes cancelling my place if I present with any symptoms that require consultation with my GP.

Any questions or comments for Sheena?

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.