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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
-- Select --
Asian African
Asian Bangladeshi
Asian British
Asian Indian
Asian Pakistani
Asian Other
Black African
Black British
Black Caribbean
Black Other
Mixed White/Asian
Mixed White/Asian African
Mixed White/Black African
Mixed White/Black Caribbean
Mixed other
White British
White African
White Eastern European
White Western European
White Other
White Irish
Arab
Chinese
Latin/S American
Somali
Other
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 Low
Low
Okay
High
Really 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
Done
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