Sign Up Form - Breathe Poetry for Mindfulness

Thank you for your interest in Breathe Poetry for Mindfulness, Fri 20th May, 1pm-2pm, online (Zoom).

Please note, this Breathe Poetry for Mindfulness is only open to staff at Guy’s and St Thomas’ NHS Foundation Trust.

We look forward to welcoming you.

Personal Details

Fields marked with * are mandatory.

*First name/s: *Surname: Mobile number: *Email: *Confirm email: What is your role in the Trust? Which GSTT hospital / unit/ community site are you based?

How did you hear about Breathe Poetry for Mindfulness (select from dropdown) Where will you be joining the sessions from? (select from dropdown) Do you have any access or support needs to ensure you can take part in this activity? (E.g. wheelchair access, captioning for online activity, large print information, sign language interpretation) If you answered yes to the question above, please give detail below:

I agree to Breathe Arts Health Research occasionally taking screenshots or short recordings of online sessions for promotional and reporting issues. (No personal details will be visible).
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Yes, please sign me up.

By submitting this form you are consenting to our privacy policy.

More information including the Zoom link will be sent to you in advance by email.

Help

If you require any help completing this form or would like to receive it in a different format, please contact Jo, our Project Engagement Officer at jo@breatheahr.org.

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Sign Up Form – Breathe Poetry for Mindfulness

Personal Details

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