RAISE Registration Form

  • Register with the RAISE Programme

    By completing this form you are allowing the sharing of your personal information with the RAISE programme, which is managed by SNVB (charity number: 1104848) and by providing your details here you are consenting to our programme staff collecting data about you and your personal circumstances in order for us to provide you with the support you need and to inform our funders about the people we support (we will never share your personal details with anyone - all data is secure and processed anonymously). The form will offer you to select a service; Pregnancy Support with Milk&You, Infant Feeding Support with Milk&You and Membership to the Maternity and Neonatal Voices Partnership. Please select the one you wish to use today.
    • We cannot accept referrals from friends or family members due to data protection laws
    • We must have consent from the parent in order for a referral to be made

     

  • Are you a....*

  • Professionals Details

    If you are a professional referring a parent to our service you must have gained explicit consent prior to completing this form. Please enter your details below so that we can contact you if necessary. You will also get a confirmation email of your referral.
  • Referring Organisation
  • Please tell us your role*
  • Is there a feeding plan in place? We will request consent from the parent to contact the clinician to understand more about the support provided.*
  • Does the parent require help with Breast Pump Loan/Emergency Feeding Equipment/Formula?
  • Would you like us to call you before contacting the parent?*
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  • Parent's Details

  • Parents Date of Birth *
     - -
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  • Preferred method of communication*
  • How did you find out about us?
  • Are there any additional needs you would like to tell us about? We can arrange specific support if required. Bringing a supportive person/carer to our sessions is welcomed.*
  • Do you require an interpreter (language/BSL)?*
  • Which NHS Trust is providing or did provide your maternity/neonatal care? (Select ALL that apply)
  • What project do you wish to access?
  • Milk&You Pregnancy Support

    Milk&You Pregnancy Support

    This support service is designed for all mothers and their families, who wish to learn about breastfeeding and how to feed their baby and get support with feeding after birth. We offer antenatal education online and in person, peer support groups, online, video and phone support. It may not be something you have thought about yet and that is okay. We are here when you need us, and would encourage you to learn more before your baby arrives, to make making feeding decisions easier.
  • When is baby due to be born?
     - -
  • Do you want us share information about Pregnancy Education Sessions (infant feeding, transitioning to parenthood, relationships and feeding).
  • Feeding Goal:*
  • You are welcome to come along to any of our infant feeding groups to see how Milk&You run our support sessions. When you submit this form one of our staff will contact you to give you further information about our antenatal sessions and support. Please let us know if this is okay with you.
  • Milk&You Infant Feeding Support

    Milk&You Infant Feeding Support

    This support service is designed for all mothers and their families, who wish to get information and support around feeding during pregnancy and after birth. We offer educational sessions, home visits, peer support groups, online, video and phone support. This service can also be used by any parent/carer who wishes to get help with feeding a child under 2 years.
  • When was baby born? (If you a pregnant and wanting support for your older child e.g. weaning from the breast, please add their date of birth here)*
     - -
  • Current Feeding Method:*
  • Feeding Goal:*
  • What feeding concerns do you feel support is needed with? Select all that apply*
  • If pregnant/expecting a baby, we offer breastfeeding/transitioning to parenthood sessions before baby arrives. To find out more, select an option below.
  • Maternity & Neonatal Voices Partnership

    Maternity & Neonatal Voices Partnership

    The MNVP (Northamptonshire) is a service-user led group of parents (members) who feed back to our MNVP champions (parents specifically trained to listen and collect feedback) how they felt about the care they received from their NHS maternity/neonatal provider. We offer listening circles for parents to share their experiences, focus groups for you to help influence change, workshops to support production of new resources/services and events. We welcome all parents who have experienced maternity or neonatal care at Kettering or Northampton General Hospitals in the last 3 years. We also want professionals/stakeholders to be part of our MNVP quarterly meetings to listen to the voices of families and help us to implement change.
  • Would you be interested in supporting the MNVP in any of the activities below (parents/professionals)?*

  • Equality Monitoring

    The next set of questions asks about demographic data.Your personal data will never be shared with a third party and any data we do collect for funding purposes will be anonymised. You do not have to complete this part however, it does help us secure funding from sources when we can prove we are helping all of our community. 
  • What is your age?*
  • What is your ethnicity/ethnic group?*
  • Gender identity*
  • Relationship Status*
  • Sexual orientation*
  • Employment/socio-economic status*

  • Data Protection

    By submitting this form, you are agreeing to allow SNVB to hold where you have provided, any information about you. You can withdraw or change consent by emailing michelle@daventryvolunteers.org.uk. Please note that all processing of your data will cease once you withdraw consent, (this may take up to 10 days to action) other than where it is required by law. You can find more about how we use your data from our privacy policy. 

     

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