Alexander Technique course booking form

Alexander Technique Pre-Course Form

Please complete the form below before you join one the Alexander Technique Courses at Sir John Deane’s College, Northwich. Any information given is strictly confidential and will be kept securely according to data protection legislation and will be destroyed after 5 years.

COURSE DETAILS (PLEASE SELECT)

Alexander Technique Workshops

YOUR DETAILS

Name:

Address:

Phone:

Mobile:

Email:

Emergency contact number:

ABOUT YOU

1) Where did you find out about this course?

2) Please give details of any previous Alexander Technique courses or lessons you have attended:

3) Do you have any visual or hearing impairment which could make participating in the workshop difficult for you? If yes, please provide details, thanks:

4) Do you have any physical illness or limitation(s) that may make sitting, lying or movement difficult for you? If yes, please provide details, thanks:

5) Please indicate briefly what has drawn you to the course:

Data Protection Policy and Privacy Policy

I have read and agree to the Data Protection Policy and Privacy Policy.

Participant's Signature: (a computer-generated signature is fine)

Date:

Please feel free to contact me if you need more information.

Many thanks,
Kind regards,
Wendy

Booking:

All bookings and payments are taken by the Adult Education Department at Sir John Deane’s College, Northwich.

Tel: 01606 810025

What do I need?

Please bring a mat (a Yoga mat or camping mat is fine), warm blanket (very important!), 2 thick paper-back books or towel (to use as a head rest when lying down).

Please wear warm, comfortable clothing and bring extra socks to wear when lying down.