Brunch Bunch club for adults with learning disabilities

Name of person applying for the group (required)

Contact email (required)

Postcode

Contact telephone

Please briefly describe any cooking experience you have.

What cooking facilities do you have where you live?

How did you hear about this course?

Do you have any food allergies or dietary requirements? Please note we try our best to accommodate these but we will contact you to discuss if needed.

Please tick to indicate any relevant health information:
Physical health conditionMental health conditionLearning disabilitySubstance issues

If you have ticked a box please give some details:

Please tell us about anything else which could affect your ability to work in a group so we may ensure your enjoyment and safety.

Please give us the name and phone number of someone who can be contacted in an emergency.

Are you filling out this form on behalf of someone else?
YesNo

If you are not the person attending the course, please give details/ your relationship.

Will a carer attend sessions alongside the participant?
Yes, first session onlyYes, throughoutNoUnsure

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