MindSpace Registration

We would be grateful if you could complete this registration form in advance of coming along to your first MindSpace session. This is not a requirement though. You are very welcome to just turn up if you prefer.

We are looking forward to meeting you at one of our upcoming MindSpace groups!

Please complete this registration form in advance of coming along to your first session. Collecting these details means that we can support you most effectively, but also so that we can get in contact with you if we are moving our walk to a local café due to bad weather.

If you have any questions please don’t hesitate to contact the team at community@derbyshiremind.org.uk

MindSpace Registration

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This field is for validation purposes and should be left unchanged.

First Name(Required)

Last Name(Required)

Preferred contact phone number

Email Address (We will use this to update you on any changes to walk plans including due to bad weather)(Required)

Postcode(Required)

Date(Required)

Gender(Required)

Please tell us how you identify

Enthnicity(Required)

Please tell us what ethnicity you consider yourself

Which MindSpace Group(s) would you like to register for?(Required)

Friday Mornings - Markeaton Park (Fortnightly)

Wednesday Evenings - Markeaton Park (Fortnightly: May -Sept only)

Monday Afternoons - Sinfin Moor (Fortnightly)

Thursday Mornings - Queens Park Chesterfield (Fortnightly)

Tuesday Afternoons - Swadlincote Woodlands (Fortnightly)

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I consent to my information being held by Derbyshire Mind(Required)

Yes

I consent to my information being held anonymously

Derbyshire Mind collects and keeps secure personal information for the purposes of recording data when reporting to our funders and for reporting on our work and outcomes for our beneficiaries. Please give consent so we may use your data to promote our work and report to our funders. Your information is kept private and secure.

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