Community Roots

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Lancashire Community Roots Enrolment Form

Account settings

Email Address

Password

Confirm Password

Your details

First name *

Surname *

Mr / Miss / Mrs / Ms / Mx / Dr / Prof / Rev *

Date of birth *

Date

Home address *

Address 1

Address 2

City

Country

County

Postal Code

Mobile/home phone number *

In future, we may be able to offer a text reminder service. Would you like us to contact you this way? *

Yes

We work with a range of partners to signpost you to additional support and opportunities. We will always discuss any signposting opportunities with you before any referral is made. Do you consent to us sharing your contact details with approved partners? *

Yes

Are you currently accessing LSCFT Services? (Directly or as a carer for someone who is?) *

Yes

I'd prefer not to say

If yes, can you tell us which services you are accessing?

Are you currently a: *

Service User (accessing LSCft services)

Carer (providing unpaid care/support to someone that relies on you)

Community Member

Staff of LSCft

Partner

Student

Do you require any additional support? E.g. you may wish to book an interpreter, provide an easy read version of the information, etc. This is editable in your profile. *

Yes

If yes, can you tell us which support you require?

If you would like to receive emails from us to let you know about new sessions and opportunities, just select an option from the dropdown below. You can choose to opt out of receiving emails from us at any time we will not share your details with any other organisations.

I agree to the storage of this information, and to the privacy policy

Yes

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