Window Boxes for Wellbeing

Nomination Form

If you can think of someone who would benefit from Window Boxes for Wellbeing initiative, please nominate them to receive one of our window boxes.

This person could be shielding for health reasons, or perhaps they have struggled during lockdown and would enjoy receiving this gift from you.

At present nominations are open to Pontypridd residents only and priority will be given to the elderly, people who are sheilding for health reasons and victims of flooding.

Supported by the Lottery Community Fund, RCT Covid Community Activities grant & Cwm Taf Health Board.

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* 1. Your Name?

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* 2. Who would you like to nominate?

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* 3. What is your relationship to this person?

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* 4. Why would you like to nominate them?

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* 5. If you can, tell us a little bit about them and their interest so we can tailor the box contents (for example their age group, hobbies and similar).

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* 6. What is their full address and postcode?

Name

Address

Address 2

Postal Code

Any personal information given in this survey will be safely stored and will not be shared with any third parties.