Meditation Capsules -Certificate in Creative Mindful Education for Children

APPLICATION FORM FOR CERTIFICATE IN CREATIVE MINDFUL EDUCATION FOR CHILDREN
This course includes:
- 4 Core Training Manuals (PDF’s)
- Coaching Calls
- 2 x 1 Day Immersions
2021 Day Immersion Dates:

Training Day 1: Saturday July 10 2021

Training Day 2: Saturday October 9 2021

Students will be required to attend both dates (online - via Zoom)
Name *

First Name Last Name
Do you go by any other name? (Maiden name)
Occupation *
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Postal Country
Phone (Mobile) *

Area Code Phone Number
Phone (Home)

Area Code Phone Number
Age *

18-25yrs 26-30yrs 31-35yrs 36-40yrs 41-45yrs 46-50yrs 51-55yrs 56-60yrs 61-65yrs 66-70yrs 71-80yrs
How did you hear about this course? *

Meditation Australia ACMM (Australian Centre for Meditation andMindfulness) Facebook Google Search Instagram Another Meditation Training provider - please list below Another professional association - please list below Word of mouth
Other Meditation Training provider or Professional Association (If applicable)
Have you completed any previous Meditation Teacher Training successfully? *
Have you completed any Positive Education or other Meditation or Mindfulness Training (Other than Meditation Teacher Training)? *
What do you intend to do with this qualification? *
Please indicate your preferred time for coaching calls from the following options, by ticking 2 boxes. (Please note time frames are in Australian Eastern Time). Available times change from time to time. Morning times start at 9.30am. *

Monday afternoon Tuesday morning Tuesday afternoon Tuesday evening Wednesday morning Wednesday afternoon Wednesday evening Thursday morning Thursday evening Saturday morning
Please upload a photo of yourself to share with Janet only.

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Please upload a Working with Children Check *

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Please upload a hand written personal reflection on why you feel inspired to commit to the course, and to share your heartfelt wishes of what you want to learn and achieve *

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Please provide an emergency contact - Name and phone number.
Payment Details

PAYMENT METHOD.

Course Investment: (To enrol in this training you will need to enrol in all units and both immersions regardless of when they are attended)

There are 2 payment methods: Upfront or Payment Plan.

	Upfront Only
4 Units	$1250
2 x Day Retreats	$350
TOTAL	$1600

International Students can pay via Paypal

Students in Australia:

Our preferred mode of payment is by Internet Transfer.

Bank details for transfers as well as the Paypal payment link will be emailed to you once your application is approved.

Chosen Payment Method *

Upfront by Internet Transfer Upfront by PayPal
I would like to apply for a Concession Rate (15% discount). Please upload a photo of your concession card.

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I do not have a health care card but my child does (for a parent of a child with a disability) (15% discount). Please upload a photo of your child's Health Care Card.

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*Please note only one discount category applies. Maximum total discount 15%.

Your enrolment will be complete once payment has been received.
Training Agreement Meditation Capsules and Australian Centre for Meditation and Mindfulness (ACMM)
Agreement between

MEDITATION CAPSULES, ACMM and Student (as mentioned on above enrolment form).
- I am over 18 years of age.
- I understand that some aspects of my Learning Journey may be shared by the trainer in professional supervision sessions with a training supervisor for professional development purposes only.
- I am assured that the information I provide on this form is kept by Meditation Capsules and ACMM in accordance with the Health Privacy Act relevant to the country and state in which this training occurs.
- I understand that all materials supplied to me and processes contained within the course are copyright and remain the property of Meditation Capsules and ACMM.
- This course does not accredit or train me to run Meditation Teacher Training courses.
- I take full responsibility for any additional support I personally may require. I can do this by booking in with a practitioner of my own choosing either from ACMM or elsewhere and making use of the processes provided to me for my own home support.
- I understand that I have 30 days from date of enrolment in which to confirm that the course meets my expectations. After this time no refunds will be issued. Please note that if you are a delayed starter, as the 30 days starts from your commencement date, not enrolment date.
- This course is designed for responsible and healthy adults and is for educational purposes only. It does not replace counselling, psychiatric or medical support. Participation is voluntary and proceeding to undertake this programme is an indication that you agree to take responsibility for your wellbeing.
*

I have read and agree to the above Training Agreement
*

I have read and agree to comply with the ACMM Policies & Procedures
Policies and Procedures
The prerequisite for this course is a committed meditation practice, preferably with training provided by an accredited teacher. It is also of paramount importance that any personal mental health issues are addressed. To teach meditation and mindfulness requires a sound, grounded presence to compassionately, sensitively and wisely care for the needs of each child.

If this is a time when you are feeling severely affected by any mental health condition, then this may not be the right time to begin this course of study. We suggest that you seek professional mental health support and advice before doing so.

Please contact janet@meditationcapsules.com if you have any questions or concerns.

If anything uncomfortable happens that becomes persistent whilst you are meditating or afterwards, ask an experienced meditation teacher such as your coach or a meditation teacher with mental health experience.

We are here to support your wellbeing and an optimal study experience.
*

I have read and understand this advice.
Date

Day Month Year
Date
WHAT HAPPENS NOW?

Once you click SUBMIT on your enrolment form you will hear from us in the next 48 hrs. Please check the email address that you have placed on your enrolment form. (Please also check your SPAM folder)

In the next 48 hrs you will be advised whether your application has been approved and if so, you will receive a Welcome email that contains some initial information as well as other administration information.

You will receive further course information a little closer to your course commencement time of 26 March 2021.

If you do not receive any emails from us in the next 24-48 hrs and you have checked your SPAM folder, please email melinda@meditationandmindfulness.com.au or call 03-9807 4889.

If you have further questions about the training, please contact Janet by email.

janet@meditationcapsules.com

We are looking forward to welcoming you !
Janet Etty-Leal and Lisa Forde
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APPLICATION FORM FOR CERTIFICATE IN CREATIVE MINDFUL EDUCATION FOR CHILDREN

Payment Details

Training Agreement Meditation Capsules and Australian Centre for Meditation and Mindfulness (ACMM)