CJ's Women's 'Big Day In' 2021

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CJ's Women's 'Big Day In' 2021 - Registration Form

We thought you may be interested in ClementJames' Women's 'Big Day In' on the 10th March 2021. We have partnered with the British Library to bring this exciting event online!

The day will run from 10:45am until 3:00pm in three parts: we will begin by watching a virtual exploration of photographer Khadija Saye's exhibition 'In This Space We Breathe'. We will then host a live Q&A session with the exhibition's curator Marion Wallace, where we will be able to discuss the exhibition further and ask any questions. After a break for lunch, we will return for a workshop with spoken word artist, editor and publisher Kadija George. This will be a fantastic opportunity to meet new women, explore artwork and get creative!

Please read the below registration form carefully, and fill out all required fields. We know that some of you will have shared this information with CJ before, but we do need to gather it again for this specific event.

We will only be able to send you the Zoom link for the day once you have completed this registration form. We will be notified once the form has been completed, so no need to let us know once you're done. As a thank you, all event attendees will be entered into a raffle to win a £20 Amazon voucher!

Khadija Saye tragically died in the Grenfell Tower fire. Though the various sessions do not directly focus on Grenfell, there will be occasional mentions throughout the exhibition, which some attendees may find distressing. Your comfort and safety is our highest priority, and we understand that it may be necessary to take a short break away from the event, or leave altogether. We will also be able to signpost to specialist support services if required. For more information about this and for any questions about the event, please do not hesitate to contact ellie@clementjames.org.

Privacy statement *

At The ClementJames Centre, we’re committed to protecting and respecting your privacy. In order to process your registration and to provide the best possible service to you we need to collect certain information about you and your circumstances. When you give us personal information, we take steps to ensure that it’s treated securely and confidential. We may need to share some of your information with our funders. This can be either in an anonymised or non-anonymised form. We need to do this for monitoring purposes of the grants they give us to run our services. You can view our full privacy policy on our website: https://clementjames.org/privacy/

I have read the above and agree to the terms laid out in the privacy statement

Required

Name (first and last) *

Date of birth *

YYYY

Address and Postcode *

GP practice *

Please provide the name of the GP practice where you are registered

Mobile number *

Email *

Emergency Contact Name *

Emergency Contact Number *

Please specify whether you have any medical conditions, allergies or disabilities that ClementJames should know about *

Baseline Questions

The information gathered from the below questions will be used to measure if, over time, there are any changes in your wellbeing as a result of attending Wellbeing activities at ClementJames. The results will be used solely for the purpose of reviewing and improving our services and demonstrating the impact of our work to funders.

Below are some statements about feelings and thoughts.

Please mark the number that best describes your experience of each over the last 2 weeks:

I’ve been feeling optimistic about the future *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling useful *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling relaxed *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling interested in other people *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve had energy to spare *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been dealing with problems well *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been thinking clearly *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling good about myself *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling close to other people *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling confident *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been able to make up my own mind about things *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling loved *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been interested in new things *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling cheerful *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

I’ve been feeling cheerful *

1- None of the time

2-Rarely

3-Some of the time

4-Often

5-All of the time

Confirmation *

I intend to attend CJ's 'Big Day In' (Wednesday 10th March, 10:45 - 3:00)

I will email ellie@clementjames.org if I am no longer able to attend

I understand the 'Big Day In' event will take place over Zoom, and that on the 10th March I will need to follow the link sent to my by email to access the event

In order to show the facilitator I am engaged with the workshop, I agree to have my camera on where possible (for at least the majority of the time). I will also have my mic on mute unless I am engaging in discussion or asking a question

Required

Date of registration *

YYYY

Many thanks, we look forward to having you join us!

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