Visit a Happy Hub

If you’d like to register someone to attend one of our 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*

Name

Relationship

Telephone

Should this be the first point of contact?

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?

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.