Lucy's place CIC: Community wellbeing meets in the outdoors registration form
Hello I'm Lucy of Lucy's Place CIC. Thank you for enquiring about Lucy's Place CIC community wellbeing events. Our meets are organised for Lucy's Place CIC by experienced and qualified instructors at Whiteadder Watersports Centre Trust, by international mountain leader Dr Richard Phillips and by mindfulness practitioner Joyce Lukkes, We are delighted to work in partnership with these organisations to offer a range of activities that aim to develop a community of support with like-minded people, a sense of achievement and above all enjoyment! No experience is necessary - its all about having fun together in the outdoors. These activities are open to all to apply, but thanks to funding from GMCC and Crystal Rigg Community Fund priority will be given to specific populations. Places are limited so please apply early and complete the following application... 

I hope to see you at one of our events soon

Best Wishes
Lucy

Dr Lucy Abraham - Director and Founder Lucy's place CIC - Consultant Clinical Psychologist
www.lucysplace.org
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1. Please select the wellbeing events you would like to join us for... *
Required
Your Name: *
Date of Birth *
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Address:  *
Telephone number:  *
Email address: ( please note the is the main way that event organisers will contact you about the event): *
Emergency Contact name: *
Relationship with emergency contact:  *
Telephone number of emergency contact: *
Swimming declaration: Please tick the relevant boxes to confirm that you are able to:  *
Required
Community meets aim to improve health and wellbeing. Please rate your current mental health and wellbeing: *
Very poor
Excellent
Community meets aim to improve health and wellbeing. Please rate your current fitness level:
 *
Very Poor
Excellent
Health Conditions: Please note any health conditions that you feel are relevant. The activity provider may wish to discuss these with you prior to the event.  *
Any other information that may be relevant to you engaging in this activity and having a safe and enjoyable experience  *
Do you give permission for photos to be taken during the event for the purpose of social media and promotion: *
Are you are priority group for these activities? *
Thank you for completing this form. Please be aware that by submitting this form you agree to the above information being shared with the relevant activity provider, specifically Whiteadder Watersport Trust, Joyce Lukkes and Dr Richard Phillips at Wild Caledonia. Please state below date of agreement:  *
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