020 8755 1336 Monday - Friday 9:30 - 12 noon 1 Library Way, Whitton, Middlesex, TW2 7AP
Registered Charity No. 1117627

WE HAVE RE-OPENED FOR TRANSPORT - PLEASE DO GET IN TOUCH ON 0208 755 1336

Become A Client

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.

Client Application Form

Please complete and send the form below

    Do you have a disabled persons car badge?
    Do you live alone?

    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.

    Do you want to be invited to half day Outings which include a sandwich lunch or tea?

    Do you want to be invited to a full day Outing which includes lunch and two comfort breaks for coffee or tea?

    Do you want to be invited to the annual Tea party?