Nature Club Registration Form

To join one of our community projects we need to collect some information to help us create a safe and supportive space for you. If you have any questions or need any help with completing the form let us know. You can also complete it on a paper form at an upcoming session. We will not share your personal details with anyone external to our organisation. When we have guest speakers we will share the collective needs of the group as opposed to any individual requirements.

Once you have completed this form we will be in touch with you about joining a session. We normally have a session for new members to join every 6-8 weeks.

Name

First Name

Last Name

Pronouns

eg. she/her/he/him/they/them etc.

If you do not have an email address please write that and then give us a contact number

Telephone number

Address

Do you have any allergies, medical conditions and/or injuries?

We are asking you this so we can keep you safe during the session. It also helps us to plan accessible session activities that everyone can take part in comfortably. So you only need to let us know about things that will enable us to keep you safe. Eg. if you have a contact allergy to a plant or are allergic to bee stings and carry an epipen, if you cannot walk long distances or you find it difficult to bend down etc.

Do you have any additional needs? Here is an opportunity to let us know other things that might affect you during sessions.

You may also choose to share information so that we have an awareness of what's going on for you so we can better support you in the moment. e.g. a recent bereavement, feeling anxious in large groups, sensitivity to loud sounds, experiencing panic attacks etc.

In case of emergency, who should we contact?

Name

Emergency contact telephone number

How did you find out about Hackney Herbal

Eg. through a community course, a friend, a referral, an event etc.

Photography Permission

We will check with you when we are taking photos during sessions if you are happy to be in them but it's also helpful for us to know more generally how you feel about photos. We take photos mostly to share internally amongst our community groups. We also share some photos publicly and with our funders to celebrate our work and our community... YOU!

I am happy to be in photos that are shared publicly

I am happy to be in photos that are shared internally eg. in Group whatsapps

I am happy for 'hands only, no faces' photos to be shared publicly

I am happy for 'hands only, no faces' photos to be shared internally eg. in Group whatsapps

I am sometimes happy to be in photos shared publicly and/or internally so ask me on the day

I would prefer to not be in any photos that are being taken

Please let us know any other information to help us make sessions comfortable and relevant for you (optional)