WSWS Self-referral form

Current Self-referral form WSWS
Complete

Your details

First name

Last name

Date of birth (DD/MM/YYYY)

Address

Postcode

Contact number

If you are under 18, please tick this box to indicate you have received parent/guardian consent to get in touch with us

Yes

Parent/Guardian full name (if applicable)

Parent/guardian contact number (if applicable)

Parent/Guardian contact email (if applicable)

How did you hear about us?

How would you like to get involved?

There are a number of ways you can get involved with us. Please choose from the list above the option you would be most interested in.

What do you hope to gain from attending these nature for wellbeing sessions?

Is being with a group of eight people okay?

Yes

Details of allergies, physical or mental health concerns, learning disabilities or other needs:

Is there anything else you wish to tell us about?

What is your current occupation?

Unspent criminal convictions in accordance with the Rehabilitation of Offenders Act 1974 (exceptions) order 1975 &/or (NI) 1979

Data Protection

By signing up to our mailing list you are opting in to receive emails about Wild Skills Wild Spaces events, and our further work. We respect your privacy and will never share or sell your details, and you may change your preferences at any time.

Please be aware that this information will be stored securely and retained at least until 31 December 2026, in compliance with the Data Protection Act 2018. For further information please click here to view our privacy statement call or email us on 01938 555654 info@montwt.co.uk

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WSWS Self-referral form

Your details

Equal opportunities

Data Protection

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