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Nurture Group Booking form

1.Which nurture group are you signing up for?
2.Name
3.Phone number
4.Email address
5.Postcode
6.Child's diagnosis (if there is one)
7.Child's age
8.Very briefly, what attracts you to this course?
9.Where did you hear about us?
10.Do you have any dietary requirements?
11.Do you have any accessibility requirements? The final part of the sessions includes the option of sitting/lying on a yoga matt for guided relaxation - would you prefer a chair?
12.Any other medical information(for you) we need to know about?
13.Emergency contact name and number (in the unlikely event your fall ill during our session, the personal contact you would like us to contact)
14.By signing up, you are agreeing to your details being stored by Murmuration Community Therapy for admin, monitoring and future event invitations. You can unsubscribe at any time. Please email to request a copy of our privacy policy.
We want to make sure that nurture groups are accessible to SEND parents of all walks of life, rather than favouring a particular group. By answering the following questions you will help us ensure that we are supporting a wide enough variety of people.
15.What is your age?
16.Do you consider yourself to be a disabled person?
17.What is your sex?
18.Have you gone through any part of a gender reassignment process or do you intend to?
19.What is your ethnic group? (please tick one box only)
20.What is your sexual orientation?
21.What is your religion / faith?
22.Are you a refugee or asylum seeker?
Current Progress,
0 of 22 answered