First Name

Last Name

Phone *

Email *

Session Preferred Day *

Session Preferred Time *

Photo & Video Consent

Embrace Community Care may take photos/videos during support activities. We may use these for positive promotion or internal purposes.

Please tick ✔️ for YES in each option:

Use

Promotional materials (e.g., brochures, videos)

Social media (Facebook, Website)

Newspapers or magazines

Internal display (e.g., team boards or photo walls)

*By providing your details you consent to being contacted by our friendly Affective Care support team