You are here: Home / Patients, family, friends / How can we assist you? / Exercise and meditative courses / Life Now Course Application Form

Life Now Program

Course Application Form

For information about details we are collecting from you, please see our Privacy Statement.

For details of all classes currently scheduled, please see our Calendar of Life Now courses.

Life Now Course Eligibility Criteria

Yoga and Meditative courses: these 6-8 week courses are for Western Australians diagnosed with cancer, or who have experienced a recurrence, secondary or progression, within the last 5 years, and their primary carers.

Exercise course: the 12 week Life Now Exercise course is for Western Australians who have been diagnosed with cancer within the last two years, are currently undergoing cancer treatment or who have completed cancer treatment in the last two years. Primary Carers are eligible to attend with the patient. Please note some health-related eligibility criteria apply. We will ask you about these contraindications when we contact you to confirm your registration.

(* denotes mandatory fields)

Please note that, except where indicated otherwise, participants must be 18 years or over. Other exclusion criteria may also apply to some programs.

If you see this field, please leave it blank and invest in CSS support.

Website

Course Selection

Please indicate your preferred course type and location, based on availability within the Course Timetable*

Your Details

Please provide the following details:

Title:

Title other

First name:*

Last name:*

Address type:*

Home

Business

Do you live in Australia?*

Yes, I live in Australia.

No, I live Overseas.

Find your address

Address:*

Suburb/Town/City:*

State/Territory:*

Postcode/Zip:*

Country:*

Email:*

Confirm email:*

Preferred phone number:*

Alternate phone number:

Date of birth:

We ask for your date of birth to enable us to distinguish between participants of the same name.

Emergency Contact

Name:*

Relationship:*

Phone number:*

I have read the eligibility criteria and confirm that I am eligible to participate in the course/s selected. *

I accept

I understand that my registration is not confirmed until a member of the Life Now team has been in touch with me by phone or email to discuss my application. *

I accept

Patients, family, friends