Register Your Details

Welcome to Take P-heART.This registration form is for people who attend Take P-heART, and is primarly to assist our reporting back to the Community Interest Company Commissioner, as evidence that the service we provide is needed in the community. And to comply with local fire regulations. If you have any questions, please let us know.

 

Full Name

First name is required.

Last name is required.

Address

Street address is required.

City is required.

Postcode is required.

Contact Details

A valid email address is required.

A valid phone number is required.

Accessibility

Are you D/deaf? No Yes

Please select an option.

Do you have any mobility access requirements? No specific requirements Wheelchair Access required Scooter Access required Other assistance required

Please select your mobility requirements status.

Would you also like to register for BSL Practice Partners to practice your signing?

Are you registering as a carer, on behalf of Assisted Living or a Residential Home?

Assisted living / Residential Home Name is required.

I consent to my data being collected and stored according to the GDPR policy. Read our privacy policy.

You must consent to the GDPR policy.

Register