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North Kent Mind

for better mental health

CYP Workshop Form

If you are a young person aged 5 to 18 (up to 25 with SEN, or Care Leavers) and interested in attending a B.R.A.V.E CYP Workshop, please complete the below form or for more information email: braveservice@northkentmind.co.uk

Invitations are sent via the contact details provided below (taking into account preference of workshop topics and delivery method.)

Workshops take place on a monthly basis.

CYP Workshop Sign up Form

CYP Personal details

Forename:

Surname:

(Preferred Name):

Gender:

Male

Female

Prefer not to say

Other

If other, please specify

Date of Birth:

Ethnicity:

Preferred email address*:

Preferred contact number*:

Home address (including postcode):

Address Line 1

Address Line 2

City

County

Post Code

Physical Disability:

Yes

No

Please specify:

Additional needs (e.g. SEN):

Yes

No

Please specify:

Emergency contact details

Forename:

Surname:

Relationship to self:

Contact number

Email address

Home address (including postcode):

Address Line 1

Address Line 2

City

County

Post Code

Permission to contact?

Yes

No

Workshop topics you would be interested in joining:

Anger difficulties

Anxiety/ stress

Transitional stress

Sleep

Healthy relationships

Low mood

Risk taking thoughts and behaviours

Exam worries

Gender Incongruence

Self-esteem/Self-Confidence

Resilience

Any other topics we have not included?

Preferred delivery style?

In person

Virtual

Are you currently receiving support through a North Kent Mind service?

No

Yes

Please specify

How would you like these workshops to support you moving forward?

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North Kent Mind

The Almshouses | 20 West Hill, Dartford | DA1 2EP
Phone: 01322 291380
Email: admin@northkentmind.co.uk
Website: https://northkentmind.co.uk
North Kent Mind Registered in England Company No. 5093370 Limited by Guarantee.
Affiliated Local Association. Registered Charity No. 1103790

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