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KaS Member Registration Form

Questions marked with a * are required

Welcome to KaS Project and thank you for showing your interest to our workshops. To ensure a safe a friendly environment for all participants, we are collecting some basic information before we show you the KaS world. After submitting your registration information, you will be able to reach the KaS workshop list and choose as you wish.

Member Contact Information

Name (the name you like to go by)

Email

Phone Number (if you don’t have an email address)

DEMOGRAPHICS

Age:

What best describes your ethnicity

What best describes your sexual orientation

Heterosexual or straight

Gay/lesbian

Bisexual

Prefer not to say

Not sure

Other

What best describes your gender?

Male (including trans male)

Female (including trans female)

Non-Binary

Queer

Prefer not to say

Prefer to self-describe

What sex were you assigned at birth?

Male

Female

Undetermined

Prefer not to say

Do you consider yourself to have a disability/ies?

No

Yes

YOUR STATUS

Before the Workshop, your level of...

Really LowLowOkayHighReally high

Feeling of loneliness is..

Ability to cope with ISOLATION is..

KNOWLEDGE around health and well-being is..

AWARENESS of support services is..

CONFIDENCE to deal with issues is

How did you find us?

Which workshops are you interested in?

Domestic Violence (TWO closed Sessions)

Healthy Relationships

Loss/Bereavement

Mental health

Physical wellbeing (e.g. diet and exercise)

Resilience under Covid-19

Self Care (focuis on boundaries)

Sex under Covid -19

Socials online (physical when permitted)

Any other suggestions?

Consent

Spectra will retain a record of your name and contact detail for 1 years in order to be able to communicate with you in relation to KaS Project and its evaluation, and/or case management.

Spectra requests your agreement to retain and use your personal data for this purpose.

Spectra does not share your personal data with third parties, other than Club Kali Network in relation to this KAS project.

By submitting this form, you are confirming that you are consenting to the Spectra holding and processing your personal data for the these purposes (please tick the boxes where you grant consent):

Spectra may contact me for KaS Project evaluation

I Agree

Spectra may keep me informed about events, activities and services (note you can unsubscribe from us at any time)

I Agree

Club Kali may keep me informed about events, activities and services (note you can unsubscribe from us at any time)

I Agree

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