Wellbeing Workshop Feedback Form

Wellbeing Workshop Pre-interest Form

The Resonance Centre, 599 Ashton New Rd, Manchester M11 4SG
We want to try and get an idea of attendance numbers and background information for our Wellbeing Workshops

As such, we would be grateful if you would complete this pre-interest form as honestly and as fully as possible.
Name:*
Postcode:*
Telephone:*
Email
example@example.com

Do you currently claim benefits? (Please select which ones apply)*

	Benefit choices
UC - Universal Credit
JSA - Job Seekers Allowance
ESA - Employment & Support Allowance
DLA - Disability Living Allowance
PIP - Personal Independent Allowance
AA - Attendance Allowance
None
Prefer not to say

Below are a list of workshops and details of when they are taking place. Please select which ones you want to attend*

	Wellbeing workshop choices
1 - 5 Ways 2 Wellbeing - 18/01/24: 12.30pm to 3.30pm
2 - Break the habit - Smoking - 02/02/24: 12.30pm to 3.30pm
3 - Sleep - 15/02/24: 12.30pm to 3.30pm
4 - Healthy Eating - 29/02/24: 12.30pm to 3.30pm
5 - Stress & Relaxation - 14/03/24: 12.30pm to 330pm
6 - Confidence in communication - 28/03/24: 12.30pm to 3.30pm
7 - Mindfulness - 11/04/24: 12.30pm to 3.30pm
8 - Physical Activity - 02/05/24: 12.30pm to 3.30pm

Social Media & Marketing Preferences:

As part of our social media & marketing campaign regarding wellbeing workshops we may do the following:

	Yes	No
I am happy with appearing in photos or video footage
I am happy with providing a testimony at the end of a workshop
I am happy being a case study if needed

Equal Opportunities Monitoring:

For us to analyse whether there are any patterns in the running of our workshops, we invite you to answer the following questions. You do not have to answer them if you do not wish.
Age:
Ethnicity/ Heritage:
BMS Wellbeing CIC - Understanding you

www.bmswellbeing.com, joelwhite@bmswellbeing.com, Mobile: (+44) 07853 629 771
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