Arts Registration Form This survey is from rb&hArts, the arts team for Royal Brompton & Harefield NHS Foundation Trust, to register your interest in creative opportunities available to staff and patients.You can learn more about our programme on our website.Any data you share will be held solely by rb&hArts and will not be shared with any third parties. Question Title * 1. Which online programmes/activities would you like to register for? Live music with comedy violinist Adrian Garratt Singing for Breathing Crafts workshops and/or 121s Gardening workshops Youth Programme including Vocal Beats (music) and RBH Trailblazers (youth forum) for 13-25-year olds Other (please tell us) Question Title * 2. Are you registering interest for yourself or are you registering for someone else? I am registering for myself I am registering for a patient I am registering for a loved one Other (please specify) Question Title * 3. Please indicate your age group Under 18 18-25 26-34 35-44 45-54 55-64 65+ Question Title * 4. Please indicate which best describes your situation Current inpatient of 3 weeks or longer Current inpatient of 3 weeks or less Outpatient considered 'extremely vulnerable' to Covid-19 according to NHS and Government guidelines who has shielded in the past 6 months Family member of current inpatient Family member of outpatient Member of staff at Royal Brompton & Harefield NHS Foundation Trust Other (please tell us) Question Title * 5. Do you have any access requirements we should be aware of? Question Title * 6. Please enter your contact details (Please note your details will be held solely by rb&hArts for the purpose of administrating patient engagement and safeguarding. They will not be shared with any third parties). Name Email Address Phone Number Question Title * 7. Would you like to receive our monthly e-newsletter for updates on creative opportunities for staff, patients and their families at Royal Brompton & Harefield NHS Foundation Trust? Yes No Question Title * 8. Are there any other creative activities, performances, workshops or equipment you'd like to see? Thank you for registering with rb&hArts Follow us on Social Media: @rbharts #rbhartsInstagramTwitterFacebookLove the arts? Donate! Done