Frog on my Head: A Mindfulness Practice for Young Children and their Parents

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* 1. Name:

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* 2. Email address

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* 3. Affiliation with UW Madison (check all that apply)

UW Student

UW Academic Staff

UW Classified Staff

UW Faculty

UW Post Doc

Spouse of UW student/staff/faculty

Other (please specify)

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* 4. Degree/Department

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* 5. Ages of children living at home (Check all that apply):

0

1

2

3

4

5

6

7

8

9

10+

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* 6. Lunch Preference:

Non-Vegetarian

Vegetarian

Other (please specify)

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* 7. Do you anticipate purchasing the Frog on My Head board book and beanbag Frog for $12.61? (We just need to know how many to bring)

Yes

No

Not sure yet

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* 8. What are you hoping to learn from this session