Hangout Hub Sign-up Form
A FREE weekly online club for people aged 16-25 with learning disabilities to meet new friends, get creative and have fun! Every Thursday on ZOOM from 4-6pm for 12 weeks from early 2022.
How it works...
Fill out the form below and we will be in contact to discuss next steps, tell you more about the hub, and get to know individual support needs. We welcome any guidance that can be provided to ensure the participant is supported, to enable them to fully participate in a way that feels most comfortable. All sessions will take place through online platform ZOOM and we can provide full technical support. Art materials will also be provided. Parents / Carers are welcome to accompany participants. Any questions, please email cjcalderwood@ch1889.org or call 07399 867 605.
Participant Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
County
Post Code
Date of Birth
-
Month
-
Day
Year
Pronouns
Support / access needs? Please tell us of any information we need to know. Please keep us posted if this information changes.
Medical conditions? Is there any important medical information we should know?
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Emergency Contact Email Address
example@example.com
Parent / Carer / Key Worker / Social Worker Name
First Name
Last Name
Parent / Carer / Key Worker / Social Worker Phone Number
Parent / Carer / Key Worker / Social Worker Email Address
example@example.com
Key Worker / Social Worker Organisation
Photography: We like to take photos and videos at our sessions to share on our website, blog, and in print. Are you happy to have your photo taken to be used for these purposes?
Please Select
Yes
No
The Hangout Hub will take place on the online video platform ZOOM. (We can provide full technical support to get you started!) Do you have access to a digital device with a webcam, and access to internet that can be used for this project?
Please Select
Yes
No
Tell us about you! You could tell us why you're interested in the Hangout Hub, what activities you like doing, and what you might like to try?
Are you available on Thursdays from 4-6pm for 12 weeks, starting from Feb 2022? (Exact date to be confirmed.)
Have you been to or participated in projects at Cambridge House before?
What other clubs or services are you currently taking part in?
Anything else you'd like to tell us?
How did you find out about us?
Submit
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