Register for a funded place 2022
This form requires your details for the purpose of your participation in the Uplift  at home sessions.  Your email address and details will remain confidential and used within the coaching element of the sessions. The form will remain stored in our records.  Client safety and integrity are important values to Let's Get Going, we adhere to the GDPR requirements.

This form is to ensure you qualify for a funded place.
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Email *
Your contact number *
Your First Name *
Your Last Name *
Your Date of Birth *
Are you  shielding / vulnerable / have long term health conditions ? (Please  summarise)
We have secured funding for vulnerable women on a low income. Otherwise there is a small charge of £60 for the course, including prop pack, support and all 6 training sessions. It is possible to pay in 2 installments.
What would you like to address during this course? How do you feel and how do you want to feel?
How did you hear about this course? *
Do you have any health practitioners you would like me to speak to ? Please provide their name and email address / contact number e.g. Mental Health nurses, physiotherapists, district nurses, key workers etc
What is your postcode *
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