Attendee sign-up

Welcome to Parents in Mind Warrington. Please complete the following questions so we can understand more about you and your current situation. We will then reach out to you to find a mutually convenient time to discuss your referral further. All information shared below will be held in strict confidence within our service.
If you want to get in touch or have any questions, please email parentsinmind.nw@nct.org.uk.
Thank you!

Please note that we are not a crisis service. If you are in crisis and require immediate support please see below. These services offer confidential support from trained volunteers. You can talk about anything that's troubling you, no matter how difficult:

- If you need urgent help for your mental health please call 111
- Call 116 123 to talk to Samaritans, or email: jo@samaritans.org for a reply within 24 hours
- Text "SHOUT" to 85258 to contact the Shout Crisis Text Line, or text "YM" if you're under 19

First name *

Last name *

Date of Birth e.g. 26/05/2001

I am 16 or over

Contact relationship type You are stating that you are the adult responsible for this young person and give your consent to be registered on Upshot (which includes permission to attend sessions).

Contact first name

Contact last name

Gender *

Is the gender you identify with the same as your sex at birth?

Address line 1 *

Town/City

Postcode *

Mobile phone *

Contact email address * If you do not have an email address, please enter parentsinmind.warrington@nct.org.uk

Emergency contact details *

Ethnicity *

Child Date of Birth If you are pregnant, please enter your due date. If you have multiple children, please enter the youngest child's date of birth.

Reason for referral

How did you hear about Parents in Mind?

I give permission for the use of photos or other media featuring me (or the person for whom I'm completing this form)

I give permission to receive emails from NCT PiM Halton and Warrington via Upshot

NCT is registered as a controller with the UK Information Commissioner’s Office - registration number Z7500160.
We will use the personal information that you provide in this form and to the local Staff Team in accordance with applicable data protection laws and our Privacy Policy - available at www.nct.org.uk/privacy

We will process your personal information to decide your eligibility for the service, to match you with a suitable volunteer and to carry out our obligations under any contract between us and our commissioner. We process special category data under the health and social care condition for processing. We share anonymised and aggregated data with our funders to demonstrate the effectiveness of our service. We also use this data to check that we are reaching all members of the community, and in order to adequately safeguard service users & their dependents whilst in contact with our service. We will hold the information you provide in an electronic form for the duration of the project. The only people who will have access to this information are the NCT staff involved with the project.

I accept the organisation's Terms & Conditions and Privacy Policy *

Finally, please confirm you are a real person. *

Sign up with NCT PiM Halton and Warrington

Confirmation

Terms & Conditions and Privacy Policy