Name of Applicant *

First Name

Last Name

Address of Applicant

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Contact number

(###)

###

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Please state what course you are interested in:

Freedom Programme

Hope2Recovery

Domestic Abuse Recovery Toolkit

The Freedom Programme and the Domestic Abuse Recovery toolkit is a 12-week course. Can you commit to the 12 weeks?

Yes

No

I don't know yet

The Hope2Recovery is a 6-week course. Can you commit to the 6 weeks?

Yes

No

I don't know yet

All of our in-person courses are in the mornings, between 10.30 and 13.30. We can provide evening courses, via Zoom, but this is only when we can get enough interest to be able to facilitate the course. Please state which you prefer: *

Face to face

Zoom