Autumn Wellbeing Course

Please fill out this short form to register your interest in completing a wellbeing course. The wellbeing courses are funded by National Lottery Awards for All and delivered by Charlie Lyons from Connect In. The wellbeing courses are exclusively for parents/carers of a child or young person with a primary movement disorder.

Full details about the course can be found on the CPotential website.

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* 1. Please provide your contact details:

Your name

Email address

Phone number

Postcode

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* 2. On a scale of 1-10, (1 being a little, 10 being a lot) to what degree would you say your wellbeing has been impacted in the last year?

1

2

3

4

5

6

7

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9

10

1

2

3

4

5

6

7

8

9

10

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* 3. In what ways has your wellbeing and the wellbeing of your family been impacted?

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* 4. What would you like to gain from this wellbeing support?

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* 5. What things have you already tried to improve your wellbeing?

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* 6. Please provide any additional information: