Sukoon - Wellbeing Programme
Sukoon - Wellbeing Programme
Participant
Register
Identity
Title
First Name
*
Surname
*
Date of Birth
*
Address
First line of address
*
Town
*
County
*
Post Code
*
Demographic
Gender
*
Select Gender
Male
Female
Other
Prefer not to say
Ethnicity
*
Select Ethnicity
White or White British
Black or Black British
Asian or Asian British
Indian
Bangladeshi
Pakistani
Arab
Chinese or Other
Other
Preferred not to Say
Indonesia
Spanish
Afghanistan
Nepali
African
Kuwaiti Bidoun
Rohingya
White European
Kurdish
Black African
Iranian
Medical Conditions (Include any allergies/dietary requirements)
*
Select Medical Conditions (Include any allergies/dietary requirements)
Yes
No
Prefer not to say
If yes, please specify
Contact
Email
*
Contact Number
*
Emergency Contact Name
*
Emergency Contact Number
*
Consent
I consent to photos or videos of myself to be used for promotional purposes
*
Select I consent to photos or videos of myself to be used for promotional purposes
Yes
No
I consent to any emergency medical treatment necessary and authorise staff to perform first aid where I am injured
*
Select I consent to any emergency medical treatment necessary and authorise staff to perform first aid where I am injured
Yes
No
I agree to share my data to funders and partners on the project to enhance the project
*
Select I agree to share my data to funders and partners on the project to enhance the project
Yes
No