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Self-referral form

Use this form if you'd like to refer yourself onto one of our nature and wellbeing sessions

The Bay self-referral form

Please use this form to refer yourself onto The Bay wellbeing programme. If you have any questions, please don't hesitate to get in touch with a member of our team.

If you're looking to refer someone else onto a wellbeing programme rather than yourself, please use our referral form instead.

Referral form

 

Personal details
Is being with a group of six people okay?
Equal opportunities
In accordance with Lancashire Wildlife Trust’s policy on equal opportunities, we will provide equal opportunities to any participant and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origin, sex, sexual orientation, religion or belief, marital status, civil partnership, age, gender reassignment or disability.

We would therefore be grateful if you could complete the questions on this form. All information will be treated in confidence and is collected for project monitoring purposes only.
Gender
What gender do you identify with?
Ethnicity
Disability and impairment
Do you identify yourself as a deaf or disabled person?
Sexuality
Which pronouns do you prefer to be referred to as?

This helps us to know the best way to address you.

For example: Your pronouns would be she/her if you'd like us to say 'yes, it's her bag, she left it here' in the event of you leaving your bag behind one day.
Are you under 18?
Please tick one

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