CFF (Centre for Fun and Families Ltd)
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YOUR CART
Sign up for your FREE 90 minute Refresh online session
Please complete the information below. You will receive an email from
[email protected]
with details of how to join the Zoom session within 3 working days of submitting this form.
*
Indicates required field
Parent / Carer's name
*
First
Last
Phone Number
*
Email
*
Parent/Carer's ethnicity - click on the box to see full list of options
*
White British
Irish
Any other white back ground / mixed
White and black Caribbean
White and black African
Any other mixed background
Asian or Asian British Indian
Pakistani
Bangladeshi
Chinese
any other Asian background
Black or black British Caribbean
African
Any other black background / other ethnic groups
Any other ethnic group
Prefer not to say
Not known
This information is requested by our funders help shape future services
What issues you are currently facing at home due to COVID 19? Please tick all that apply to you and your Young Person (YP)
*
YP worries/ anxiety
YP low mood
Communication within the family
Arguments within the home
YP struggling to manage their emotions/ regulate mood
YP struggles to manage their behaviour
YP is verbally aggressive
YP is physically aggressive
Young Person's date of birth
*
Select the date you would like to attend
*
Friday 22 January 10am - 11.30am
Thursday 28 January 1pm - 2.30pm
Wednesday 3 February 6.30pm - 8pm
Wednesday 10 February 10am - 11.30am
Thursday 25 February 1pm - 2.30pm
Wednesday 3 March - 6.30pm – 8.00pm
Monday 8 March - 10.00am - 11. 30am
Tuesday 16 March – 1.00pm – 2.30pm
Tuesday 23 March - 6.30pm – 8.00pm
Wednesday 31 March - 10.00am - 11.30am
Submit
