Mindfulness Gardening Registration
Thank you for your interest in the Mindful Gardening course at St Germain's Wellbeing. This form is designed to gather essential information that will help us understand your background and ensure the suitability of the course for you. You must complete the form to secure a place on the course.

Your responses will be kept confidential and answers to the first section are used solely for the purpose of customising the program to enhance your experience on the program.

Please take a few minutes to complete the form, and feel free to provide as much detail as you're comfortable with. Thank you for your cooperation, and we look forward to supporting you on your mindfulness path!
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Full name: *
Email address: *
Phone number: *
Preferred method of contact: *
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Age
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Gender
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Is the gender you identify with the same as your sex registered at birth?
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Sexual orientation
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 Do you have any disabilities? (Please tick all that apply) *
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Ethnicity
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Religion
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Relationship status
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Occupation *
Do you have any accessibility needs? *

What is your level of experience with gardening?

 *

Do you have any specific gardening interests? (Select all that apply)

What would you like to achieve on this course? *
What is your general state of health? *
Do you have any serious or diagnosed physical or mental health issues? If yes, please briefly describe the health issue(s) below: *
Please select the option that best describes your current physical restrictions: *
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