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Five Days to Wellness Registration Form
Five Days to Wellness Registration Form
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Please enable JavaScript in your browser to complete this form.
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Email
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Address
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Afghanistan
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Do you have any of the following Health conditions?
A disability which limits my movement
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Type 2 Diabetes
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Other, please mention
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Please tell us about your other Health conditions
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Emergency Contact Details
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What are you hoping to gain from attending this program?
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How did you find out about the program?
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Are you a regular member of Croydon SDA church?
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Photographs Consent
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I consent to being included in photographs taken of the event. These will be used for sharing news of the 5 days to Wellness program and for promotion of similar programs in the future.
Acknowledge no guarantee to cure or prevention any medical condition
*
"I acknowledge this program is for educational purposes only and cannot guarantee the cure or prevention of any medical condition. I agree that any healthcare practises implemented and/or changed will be at my own discretion and should be done so alongside the clinical judgement of my healthcare provider. "
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