Visit a Happy Hub

If you’d like to register someone to attend one of ourĀ Happy Hubs, please complete the form below and one of our team will be in touch.

Note, this form is for people referring someone else to attend a Happy Hub, if you want to refer yourself, please use this form

Details:

First Name*
Last Name*
Date of Birth*
  dd/mm/yyyy

Telephone*
Does this person have an email address?

Address*
 
Town / City*
County*
Post code*

Additional Contact Information

Name
Relationship
Telephone
Email
Should this be the first point of contact?

How mobile is the person that you are referring:

Is the person that you are referring housebound?
Does the person that you are referring use a wheelchair?
Does the person that you are referring have any memory problems?
Are there any known risks associated with the behaviour of the person that you are referring?

Referring Information

Please indicate who is referring this person to the Happy at Home Project?
Contact Name*
Contact Telephone*
Contact Email

Where did you hear about
the Happy at Home Project?

Please confirm you are happy to receive emails from the Happy at Home Project.

 
 

t: 0191 529 2122

e: info@happyathomesouthtyneside.co.uk

Hours of Business: 9 - 5 Monday to Friday

Website Access 24/7

Representing 70 churches: Anglican, Baptist, Independent, Independent Methodist, Methodist, Roman Catholic, United Reformed
Registered Charity Number: 1153612

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