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Are there any particular services or courses you are interested in?*

NEWS & UPDATES

Shifa sometimes sends information about groups, events and other local services via email. Please indicate below whether you would like to subscribe to any of these emails. You can change your preferences at any time.

Please tick the box below to indicate your preference for inclusion in photos.*

I wish to receive Shifa news (including events, fundraising & other local services) by email

I DO NOT wish to receive Shifa news (including events, fundraising & other local services) by email

PHOTO CONSENT

Woking Mind would like to use photos showing clients and volunteers participating in activities, for information and marketing purposes. This may include, for example, our newsletter, website, leaflets, media releases, social media and other marketing materials. We may like to include a first name with these photos.

Please tick the box below to indicate your preference for inclusion in photos.*

I give permission for Shifa to use my photograph and first name

I give permission for Shifa to use my photograph, but NOT MY FIRST NAME

I DO NOT give permission for Shifa to use either my photograph or first name

YOUR RIGHT TO CONFIDENTIALITY

We will not normally disclose any information about you to anyone outside of Woking Mind without your knowledge or consent. We may have to, but only in these exceptional circumstances: (1) Where not to do so would break the law (2) Where there is a risk of serious harm to yourself or others. If we disclose information, we will strive to inform you beforehand and will disclose the least information necessary in the circumstances.

DATA PROTECTION

Personal information collected will be dealt with appropriately with the provisions under the General Data Protection Regulations 2018. Anonymised data may be sent to funders or used in marketing materials to inform on Woking Mind activities. We store your data in accordance with the Woking Mind Data Protection and Confidentiality policy. We also file your membership hard copy forms in locked cabinets in our office.

Please confirm that you have completed this form to the best of your knowledge by adding your name and today's date below.

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