Breathe Dance For Staff Wellbeing

Sign Up Form

Breathe Dance for Staff Wellbeing

Thank you for your interest in the Breathe Dance for Staff Wellbeing programme.

If you require any help completing this form or would like to receive it in a different format please contact us by email via

We look forward to hearing from you!

Fields marked with * are mandatory.


Personal Details

*First name/s:

*Mobile number (for possible WhatsApp Group):


*How did you hear about the Breathe Dance for staff wellbeing? (select from dropdown)

Other, Please Specify:


*Date you joined the Trust:

*What is your role in the Trust?

*Which hospital/unit/community site are you based at?


I agree that I am taking part in Breathe Dance for staff wellbeing at my own risk and it is my responsibility to ensure that the space am using to participate in is safe and free of any potential hazards. (You need to tick this box in order to be able to take part.) 

I agree to Breathe Arts Health Research contacting me. (Please tick to accept.)

I’d like to receive the Breathe Arts Health Research monthly newsletter. (Please tick to accept.) 


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