Select the program you are applying to take *

Student Class

Family Class

Athlete Program

Private Class

Participant Name *

First Name

Last Name

Participant Phone Number

(###)

###

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Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name *

First Name

Last Name

Parent Phone Number *

(###)

###

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Participant Mindfulness Experience *

No mindfulness experience

Some mindfulness experience

Practices mindfulness regularly

How did you learn about Wise Inside? *

Friend has taken a class

Other Mindfulness Group

Eventbrite

Social Media

Word of Mouth

Payment Method (Please pay immediately following completion of this form to complete registration.) *

e-transfer to hellowiseinside@gmail.com (preferred if Canadian)

I am unable to pay by etransfer. Please contact me to arrange payment.

Payment Type *

I will pay the full course fee

I will self-select a sliding scale fee

I require a full bursary. Please contact me.