bold Online Social Leadership Programme

bold Project Online Social Leadership Programme

Your name and contact details

Please insert your full name *

Please insert your home address *

Please insert your postcode *

Please insert your email address *

Please insert your contact telephone number

Emergency contact name *

Emergency contact telephone number *

Please tick this box and register below if you would like to be kept informed about any future programmes!

Privacy Statement and Image Consent link to statements

By submitting this form, I confirm that I understand how the bold Project store and use my personal information and that I agree to the bold Project using images, online session recordings and video footage that may contain my image.

What support can we help you with to get started on one of our programmes?

Do you have a computer, laptop, tablet or mobile phone?
YesNo

Is your device set up for Zoom meetings?
YesNo

Have you connected to an online meeting before?
YesNo

If no, Is there someone you are close to that can help you to connect?
N/AYesNo

We are happy to welcome a family member or friend that could be with you whilst you are getting connected and when you are online, would this help you to feel more comfortable?
YesNo

Would you like to connect with a member of the project team who can talk you through how we can support you?
YesNo

In order to ensure you have the best experience on this programme, we are keen to provide a safe space for everyone taking part. To that end, we are especially keen to ensure that potential partners living with dementia, who are unpaid carers for someone living with dementia or working in dementia care are fully supported. Please let us know if that applies to you? Please be assured that this information will not be shared with anyone outside the bold Project Team.
Living with dementiaUnpaid carer for someone living with dementiaWorking in dementia careOther
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