Additional Activities Member Organisation Existing Contact Organisation Name Please tell us about any other activity or service that your group delivers e.g. a community centre that delivers a range of activities on different days, will need to fill one in per activity. Activity 1 Name of Activity What types of services do you deliver? Arts and crafts e.g. drama, dance, performance, film and media, music and singing Emergency crisis support e.g. food banks Emotional wellbeing and mental health support Health condition support groups Local democracy and campaigning Practical support e.g. charity shops, handyman service, community transport Skills and training e.g. literacy, IT, life skills, employment support Social groups e.g. coffee mornings, luncheon clubs The environment e.g. conservation, heritage, allotments, gardening, animals, pets, wildlife Housing and homelessness support Physical activity and sport Victim support e.g. domestic abuse, hate crime Welfare, benefits and money advice Who are the main clients /users/beneficiaries of your service? e.g. If you run a youth club for children aged 6-12 then tick Children 6-12. If your activity / service is open to everyone, please don't tick anything. Black and minority ethnic Carers Children 0-5 Children 6-12 Faith communities Families and parents Homeless people Lesbian, gay, bisexual, transgender, questioning, intersex Men only Older people (50+) People with emotional wellbeing / mental health People with learning disabilities People with long term health conditions People with physical and sensory disabilities People with substance misuse/addiction Refugees and people seeking asylum Looking for employment Veterans Victims of crime and their families Women only Young people aged 13-17 Young adults aged 18-25 Please describe what your activity is and who it is for? For example – lunch club for over 50’s in Mossley, or series of jewellery making classes for people over 70 living in Dobcross. Where Activity 1 takes place Share address with member organisation Yes Address Line 1 Address Line 2 Address Line 3 Town Post Code Country United Kingdom Is there a cost to this activity? If so how much? Free £1 - £3 £3 - £5 £5 - £10 £10 - £15 £15 - £20 More then £20 What day(s) of the week does this activity take place? Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time Frequency Weekly Fortnightly Monthly Is the service accessible for disabled people Yes No Is the service accessible for people with language needs? Yes No Contact person for activity 1 Contact for Further details Phone Number Email Please confirm, are you happy for this service to be included in the online service directory of groups? Yes No Please confirm if you would like the address of your activity to be made public in our online service directory. Yes No Please confirm if you would like the telephone number of your activity to be made public in our online service directory. Yes No Relationship to Membership Contact Relationship Type(s) Employer of Volunteer is Main Contact is Contact is Grant Contact is Membership Contact is Leave this field blank
