Footprints community form
Please complete the short form below to allow Footprints to provide bereavement support.

Footprints Baby Loss stores this information for the administration of the charity and its services.  Footprints will not share this information outside of the charity without consent unless required to do so by law or in the case of a safeguarding issue where we may share personal data if we believe that there is a risk of harm to the individual concerned or to others. Your information will be kept by the charity until you let us know you know longer need our support, due to the ongoing nature of the grief journey.

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First Name *
Last Name *
Email *
Full Address (This information is required under our Safeguarding Policy but will not be shared otherwise and will only be kept in line with our Data and Privacy Policy.) *
Phone number *
Baby or Babies' Date/s of Birth/ Death *
Experience *
Please give a summary of your experience.

Type of pregnancy *
Type of loss *
What support services are you interested in?

Please note you will need to request a befriender, email to book online support groups and request to join the private Facebook group. You can do this on the website or email us and we can help
Where did you hear about us? *

Would you be willing to answer a short feedback survey after you have accessed our support? This will be used to help with funding. 
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