Thank you for your interest in the Breathe Melodies for Mums taster session for new mums and their babies.

By completing this form, you give informed consent for us to collect and anonymise your responses for internal evaluation.
We’re an independent non-profit organisation, not affiliated to any Council or healthcare services. However, anonymised data may be shared for reporting purposes, including with Lambeth Council, who are funding this programme.

Data protection:
Your information will be processed in accordance with the UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018. All personal data will be stored securely for up to 5 years, after which it is securely deleted. You can request access to, correction, or deletion of your data at any time by contacting us.

If you have any questions or need help completing the form, please feel free to contact us at m4m@breatheahr.org or call 07345 451501.

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* 1. What is your full name?
Nombre completo / Nome completo / Magaca oo buuxa

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* 2. What is your baby's name?
Nombre del bebé / Nome do bebê / Magaca ilmaha

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* 3. What is your baby's date of birth?
Fecha de nacimiento del bebé / Data de nascimento do bebê / Taariikhda dhalashada ilmaha

Date
Please note this taster session is only for mums with babies aged 0 to 9 months.

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* 4. What is your postcode?
Código postal / Código postal / Koodhka boostada

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* 5. What is your primary phone number?
Número de teléfono / Número de telefone / Lambarka telefoonka

Please note we only ask for your phone number to contact you if a session is cancelled or to share important updates.

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* 6. What is your email address?
Dirección de correo electrónico / Endereço de e-mail / Cinwaanka iimaylka

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* 7. Is there anything we should know to help make your experience with us more comfortable? (e.g. step-free access, support with mobility, etc.)
Necesidades de acceso o adaptación / Necessidades de acessibilidade ou adaptação / Baahiyaha marin-u-helka ama taageero gaar ah

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* 8. I confirm I can attend the session below (please choose your preferred venue):
Lugar preferido / Local preferido / Goobta aad doorbidayso

T