Do Your Own Thing
Starter Form

Personal Data

Name

First Name

Last Name

Phone

Address

Date of birth

Are you disabled?

Do you have a learning disability?

Do you have any support or access needs? Please tell us of any information we need to know. Please keep us updated if this information changes.

Do you have any health conditions we need to be aware of?

Is there any other important medical information we should know?

Emergency contact name

First Name

Last Name

Emergency contact phone

Relationship to participant

Key worker name

First Name

Last Name

Key worker phone

Key worker organisation

Photography

We often take photos and film at our sessions and events. By attending you may be included within our photos that we sometimes use out website, blog and print, like brochures. Are you happy to have your photograph taken?

How did you hear about Heart n Soul?

Gender

If not listed, please share

Ethnicity

Your Data

Thank you very much for filling in the starter form. The information that you’ve given is used for our own records, to make sure that we provide a safe environment. We keep this data securely and only staff who need to know the information have access. Our funders need us to have information on ethnicity, gender and disability. This is used for reports and is used anonymously. No data is given to an unauthorised third party. Please see our privacy policy for more information: www.heartnsoul.co.uk

Stay in Touch! If you would like to be updated about what happens at Heart n Soul please tick the box below

I would like to be updated about Heart n Soul projects, news, events and fundraising activities.

Yes Please!

You can remove or update your information at anytime.

Do Your Own ThingStarter Form

Do Your Own Thing
Starter Form