Mindfulness Classes and Workshop Health & Safety Questionnaire

Health & Safety Questionnaire

Before you and/or your child participate in My Little Place of Calm mindfulness and meditation course please fill out and sign the following form in order to check for suitability. All information given here is confidential.


Permission to take photographs during the class to use for promotion materials.

If at any time during the class, you feel discomfort or strain, gently come out of the meditation posture. You may rest at any time during the class. It is important that you listen to your body and respect its limits on any given day. I, the undersigned, understand that meditation and mindfulness is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a physician prior to beginning any activity program, including meditation and mindfulness. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every class and/or workshop. I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from my child, or me and my child taking part in the class.

Would you like to receive information via your email on upcoming workshops and events, new videos, blogs and anything new and exciting coming up.

Thank you

Michelle x
Chilled Out Child Facilitator Training Programme