Headspace Bolton Enrolment Form

Once you have submitted your enrolment form one of our representatives will contact you within 5 working days to provide further information on attending your chosen workshop(s).

Full Name

Your age

Address

Phone Number

Would you like to be added to the relevant WhatsApp Group(s)?

Yes

Would you like to be added to the relevant WhatsApp Group(s)?

Email.

Emergency Contact Info.

Are there any health/disability/access issues you feel are important for Headspace to be aware of?

I consent to Headspace Bolton using images of me and my work on Headspace’s Website, Social Media and promotional material. Including any screenshots of virtual sessions held by Headspace.

I have voluntarily provided the above information and authorize Headspace and its representatives to contact the person above on my behalf in the event of an emergency.

If I choose to join any social media group or organization that is linked with members of Headspace I consent to the terms and conditions of that service and will not hold Headspace responsible for the holding of personal data.

I understand I am expected to be respectful and supportive of everyone in all Headspace Bolton workshops and activities. Including conforming to any Government guidelines regarding any restrictions or periods of isolation.

I understand that in the event we are not able to meet up in person due to enforced restrictions, Headspace will provide a virtual meeting for attendance as a replacement.

I understand that Headspace Bolton reserve the right to remove anyone from any associated Whatsapp group(s) if you contact an individual without consent or post inappropriate messages or content to any Headspace Bolton group.

I understand that Headspace Bolton is not a primary care service and does not have the capacity to offer assistance going beyond the signposting and guidelines in our safeguarding policy.

Headspace Bolton Enrolment Form

Once you have submitted your enrolment form one of our representatives will contact you within 5 working days to provide further information on attending your chosen workshop(s).

Would you like to be added to the relevant WhatsApp Group(s)?

Yes

Would you like to be added to the relevant WhatsApp Group(s)?

Emergency Contact Info.

Are there any health/disability/access issues you feel are important for Headspace to be aware of?

I consent to Headspace Bolton using images of me and my work on Headspace’s Website, Social Media and promotional material. Including any screenshots of virtual sessions held by Headspace.

I have voluntarily provided the above information and authorize Headspace and its representatives to contact the person above on my behalf in the event of an emergency.

I understand that in the event we are not able to meet up in person due to enforced restrictions, Headspace will provide a virtual meeting for attendance as a replacement.

I understand that Headspace Bolton is not a primary care service and does not have the capacity to offer assistance going beyond the signposting and guidelines in our safeguarding policy.