Course Application

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Better Health Hub - Registration of Interest

Thank you for your interest in doing a course or joining a group at the Centre for Better Health. Our Better Health Hub activities aim to improve wellbeing. While our courses and groups are open to all, we particularly encourage people who are struggling with feelings of low wellbeing, isolation, loneliness, anxiety, depression or other forms or mental ill health to sign up. Before starting your application, please read and agree to the statements below:

I understand that this form is to register my interest in a group/ course. If a place on the group/course I have selected is available, I will be notified by email. Payment will be required to secure my place.

I am not a member of the City and Hackney Wellbeing Network (members should contact their Network Coordinator to enroll on groups and courses).

I have read and agree to the Better Health Hub Participant Guidelines:

Please note, if you live in the boroughs of Hackney or the City of London and you are not yet a member of the City and Hackney Wellbeing Network, you may like to apply to join. As a member of the Network, you can access 1:1 support and future courses at no cost to you. Please email our Network Coordinator, Nathan , or visit our website to find out more.

Please confirm:

Please note that space on each group/course is limited and submitting this form does not guarantee your place; confirmation of availability and receipt of payment is required.

The following courses are currently open for enrolment:

Therapuetic Support Groups:

Creative Courses/Workshops :

WCEW (Embroidery for Wellbeing)
WCWS (Make Your Own Watercolour Christmas Card Workshop)
WPCC (Make Your Own Printed Christmas Card Workshop)

Movement Courses/Workshops:

HVWS (Voice Healing Workshop, The Voice as a Therapeutic Tool)

Please enter the code(s) (up to two) of the course(s) you would like to enrol on:

If the course you are interested in is not listed above, this means it is not yet open for enrolment. Please check the website for enrolment dates, or get in touch by emailing thehub@centreforbetterhealth.org.uk

FEE

We operate a sliding fee scale for our daytime groups and courses based on your income. Please read this document and select which fee applies to you.

Which fee applies?:
*If you have selected one of our concession rates, please email your proof of circumstances to: thehub@centreforbetterhealth.org.uk
Please do not make payment until requested to do so.

PERSONAL DETAILS

First Name:
Last Name:

Date of birth (please enter as DD/MM/YYYY):

Gender:

Gender Self-Description:

Employment Status:

Current Address

Street:
Post Code:
Borough:
If you are from outside of London, please indicate where from below:

Phone:
Mobile:

Can we leave a voicemail?:

Email:

EMERGENCY CONTACT DETAILS

Please provide the details of a person to contact in case of emergency. This can be someone who is supporting you through another service, or a friend or family member. Please ensure that the emergency contact is someone who is often available.

Emergency Contact Name:
Relation to you:
Emergency Contact Phone Number:
Please confirm that this information has been provided:

DIVERSITY MONITORING

We are committed to ensuring that the clients and volunteers we work with reflect the diversity of our community, and that barriers that prevent underrepresented groups from accessing our services are gradually identified and removed. To help us to do this, we encourage you to answer the below questions.

How did you hear about our service?:

Ethnicity:

Ethnic Category - Other:

Religion or Belief:

Other Religion or Belief:

Sexual Orientation:

Other Sexual Orientation:

Housing Status:

Other Housing Status:

Relationship Status:

Experience of criminal justice system:

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Inclusion

**Please note that access to the Better Health Hub is via a small flight of stairs**

Do you have any disability, audio or visual impairment, mobility issues or any other support needs?

If yes, please give details, including any reasonable adjustments you may require. :

If you usually attend activities with a support worker, please ask them to contact us to discuss how we may be able to best support you.

Data Protection

The Centre for Better Health needs to collect this data about you in order to establish if we can provide you with an appropriate service. We will use the information that you have provided in accordance with the Data Protection Act 2018. You can read our Privacy Notice for information on how we handle this data.

Please type your name below to confirm that you agree to your data being stored and processed by the Centre for Better Health.

City and Hackney Wellbeing Network

If you live in the City of London or London Borough of Hackney, you may be eligible to join the City and Hackney Wellbeing Network. As a member of the Network, you could access courses and groups at the Centre for Better Health, free of cost to you.

I would like to be contacted by email about joining the City and Hackney Wellbeing Network:

To submit your application click "SUBMIT"