Single Parents Support Group

Single Parents Support Group

Registration and Confidentiality Form
Dear Parent,

Welcome to Single Parents Support Group.

For some, this will be your first experience of our organisation, and we warmly welcome you.

Please ensure you complete and read all sections, anything added to this form will be held in confidence.

The team at Progressay Impact wish you all the best and we hope you enjoy this much needed service.

Kind regards,

Moktar Alqaderi (PGCE, LPC, LLM)

CEO Progressay
- Are you already a Progressay Impact Member?
  
  YesNo
- If known, what is your Progressay Impact Membership number (USERID)? (Leave if unknown)
- Name*
  
  First NameLast Name
- Gender
  
  MaleFemaleOther
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Post Code
- Which borough do you live in?*
  
  Kensington and ChelseaHammersmith and FulhamWestminsterOther
- Which ward do you live in?*
- If "other", please specify:
- Date of Birth*
  
  MonthDayYear
  Date
- Age*
- Your ethnicity*
- If "other", please provide details:
- Email*
  example@example.com
- Phone Number*
  
  Area CodePhone Number
- Alternative phone Number
  
  Area CodePhone Number
- Confidentiality agreement to prohibit any discussions about the Single Parents Support Group meetings outside of sessions.
  
  This agreement is crucial to ensure that sensitive information discussed during the meeting remains within the confines of the attendees. It is important to maintain the privacy and security of all involved parties, as well as respect their wishes to keep certain information undisclosed. Any breach of this agreement could result in serious consequences, including legal action. Therefore, it is imperative that all participants understand the gravity of this confidentiality agreement and adhere to it at all times. This will help to build trust and foster open communication between all parties involved in the Single Parents Support Group meetings.
- This user registration form is not complete until the form has been signed and submitted. I hearby confirm all information provided in this user registration to be accurate to the best of my knowledge.
- Name*
  
  First NameLast Name
- Signature*
- Should be Empty: