2025 AOP Registration Form - Required
AOP are a funded service and we need to collect information to ensure that we are delivering a service that is required and reaching people that benefit from our free art for wellbeing activities. We do not share confidential information but we need these details so that we can contact you to invite you to join our courses and know a little about your needs so we can support you. The information you provide is anonymous and will not be stored with any identifying information about you. We may use anonymised statistics and data to inform discussions about improving the diversity and inclusivity of participation opportunities, but no information will be published or used in any way which allows an individual to be identified. All details are held in accordance with the Data Protection Act 1998.
The information that we are asking you to provide is informed by our duties under the Equality Act 2010, and includes information about your age, race, sex and sexual orientation.
 Many thanks for your time.  Tara Reddy.
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Email *
Do you have issues impacting on your mental health *
Are you in receipts of benefits ? *
Your Name *
Your Address *
Your Postcode *
Contact Phone number *
How would you prefer us to contact you? *
Doctors Surgery Address *
Required
Are you working with any other services? This helps us support you but you do not have to disclose if you do not wish. *
Name of services - optional but this can help us support any needs you may have.
Employment Status: *
AGE
Column 1
18 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
75 – 84
85+
Gender *
ETHNICITY *
Do you consider yourself to have any of the below? this will help us ascertain support to enable you to access our sessions. *
Required
Do you have any of the challenges listed below that make it difficult joining activity groups in the wider community (Please mark all that apply) *
Required
Please complete this form as this will support us assess needs and also supports our funding applications to provide our accessible art program.  Your personal information is not shared, however we collect the non personalised data for our reports. 
not good
changeable
good
very good
Health and Wellbeing
Confidence and self esteem
Feeling lonely
Accessing opportunities to learn new skills
Knowing where and how to get support
Accessing nature/outdoor spaces
Clear selection
Where would you like to attend? Funded sessions are held at our wellbeing hub Art in the Park and online. We are also looking for volunteers to support our programs so if this is something you would like to also consider let us know. *
Thank you for completing this form, if there is anything else you would like us to know please complete here. Your information is not shared. It is used for us to contact you and ascertain what courses you would like to attend and your support needs. Thank you.
Please add the date you completed this form and then press 'Submit', and this will go through to our admin  team. We will be back in contact to discuss courses for your to attend. *
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A copy of your responses will be emailed to the address you provided.
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