COFFEE MORNINGS NOW EVERY MONDAY AT 10.30AM AT WHITTON LIBRARY….. COME AND JOIN US
Please complete the form below to register your interest in becoming a client.
We do not share your details with any third parties except those who will be helping you.
Do you have a disabled persons car badge?YesNo
Do you live alone?YesNo
Next of Kin / Emergency Contact / Key Holder:
Your GP:
What support do you think you'd need?
Any physical / mental health details:
Do you have any special needs?
Ethic Group (for monitoring purposes only). Please ensure this is completed. It is needed for our grant.
White BritishWhite IrishWhite OtherAsian IndianAsian PakistaniAsian BangladeshiAsian OtherBlack BritishBlack CaribbeanBlack AfricanBlack OtherChineseOther
Do you want to be invited to half day Outings which include a sandwich lunch or tea?YesNo
Do you want to be invited to a full day Outing which includes lunch and two comfort breaks for coffee or tea?YesNo
Do you want to be invited to the annual Tea party?YesNo
