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Old Trauma Sensitive Yoga Registration

Please complete this application form to attend a Trauma Sensitive Yoga series. We will be in contact when the next 6 week program is scheduled. 

Register 

Start

Question 1 of 9

Full Name 

Question 2 of 9

Email Address 

Question 3 of 9

Phone Number

Question 4 of 9

Date of birth

Question 5 of 9

What are you interested in the Wild You Project?

Question 6 of 9

What day/time would you be best for you to attend sessions?

A

Tuesday morning

B

Wednesday morning

C

Thursday morning

D

Tuesday Afternoon

E

Wednesday afternoon

F

Thursday Afternoon

Question 7 of 9

Would you like your sessions to be:

A

Online

B

In your home (we travel 30 km from Newcastle CBD additional travel time fee will apply)

C

In Person on location at Newcastle West

Question 8 of 9

How will you be paying:

A

Private

B

NDIS (we are not a registered provider previously clients have used the innovative community participation or other therapy line items)

Question 9 of 9

We will contact you shortly to discuss the suitability of this program with you, would you prefer to be contacted via:

A

Email

B

Phone - call

C

Phone - text

Confirm and Submit