Online Yoga & Relaxation Classes Expression of Interest

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* 1. Background

Name:

Mobile Number:

Email:

Geographical location (County):

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* 2. Participant's Details:

Name:

Age:

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* 3. What type of disability does the participant have? (This programme is most suitable for - Intellectual Disability, Autism Spectrum Disorder, Dyspraxia, Motor Coordination Difficulties)

Physical

Intellectual

Autism Spectrum Disorder

Motor Coordination Difficulty

Sensory Disability

Dyspraxia

Other

Other (please specify)

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* 4. Please provide us with details that may help us understand any individual requirements or needs.

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* 5. Does the time of the session suit you? Monday and Wednesdays from 11.15am-11.45am?

Yes

No

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* 6. Do you have Zoom?

Yes

No

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* 7. We welcome any other comments or feedback you might have.