Name*

Email*

Phone Number*

Next of Kin*

Next of Kin Contact Number*

Postcode*

Do you or another attendee have a disability?*

Yes

No

Will you or the attendee be accompanied by a carer?*

Yes

No

Further information*

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A confirmation email detailing your booking will be sent to the email address provided. If you want to reschedule or cancel a dated booking, please contact 01928 589799 or email [email protected]

Wellbeing Enterprises aim to connect you with information, advice, and support. Sometimes it is necessary for us to share information with relevant organisations when required by law e.g., where it is necessary to protect others. We will also provide statistical data to those who fund our service, but this data does not identify individuals. All the data that we hold is held securely and subject to our data protection policy which is available at www.wellbeingenterprises.org.uk. This policy explains your rights in respect of the data we hold about you, including how you can obtain a copy of what we hold.*

If you agree to us sharing information about you as described above, please tick the box below.

Yes

No

Please do not attend the session if you have COVID-19 symptoms or you have tested positive for COVID-19. For up-to-date advice see*

https://www.gov.uk/coronavirus

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