Mindfulness Classes with Robyn Gobin

Welcome to Mindfulness Classes Interest Form! We are excited that you are interested in joining us. Please take a few moments and tell us a little about yourself and your mindfulness backgroud.

Please note, there are only spaces for 16 individuals.

1. Please briefly describe why you are interested in taking this mindfulness class.

2. What benefits do you hope to receive by participating in this mindfulness group?

3. How familiar are you with mindfulness?

Not at all

Heard about mindfulness but never practiced it

Heard about it and have attempted to practice it

Have tried it once or twice

Have taken a class on mindfulness

Practice it on a regular basis

4. How often do you have a hard time feeling relaxed?

Never

Once in a while

About half of the time

Always

5. How would you rate your current level of stress?

None at all

Mild

Moderate

Severe

Extreme

6. Do you feel as though you have a supportive community?

No

Mostly no

Neutral

Mostly yes

Yes