Staying Well - Online Self Referral Form
The Staying Well team can work with any adult in Calderdale from 18 years and over to access social activities and health and well-being related services in the community.
Consent to share your personal data
This section must be completed by the person being referred or a person with authority to provide consent on their behalf.

We recommend that you do not use this form to share sensitive information.

*
Required
Staying Well is a service of Calderdale Council. The data is centrally managed by North Halifax Partnership on behalf of Calderdale Council and the service is delivered in partnership with Halifax Opportunities Trust and Hebden Bridge Community Association. Your referral information may be shared with Staying Well staff working from any of these organisations.

North Halifax Partnership Ltd is registered as a ‘data controller’ with the Information Commissioner’s Office under the Data Protection Act. You can find out more about the Data Protection Act, and your legal rights at https://ico.org.uk

North Halifax Partnership, Calderdale Council, Halifax Opportunities Trust and Hebden Bridge Community Association will only use your personal information for the purpose which we have stated when we collect that information, and we will not collect unnecessary information about you, or keep your information for longer than it is needed. We will ensure your personal data is held securely and is not seen by anyone who should not see it.

Please click here https://northhalifaxpartnership.org/privacy-notice/ to read our Privacy Notice on the NHP website.

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To see Google's Privacy Policy click here https://support.google.com/docs/topic/2428743

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