Eat Well Basildon Registration

Personal Details

Tell us about yourself

Full Name *

Email Address *

Phone Number *

Postcode *

This helps us ensure fair access and accurate area-based support.

Area Selection

Select your location to determine the fee

Where do you live? *

Honesty & Fair Access Statement: To keep this community programme accessible and fair, subsidised spaces for Pitsea residents are funded by Cllr Aidan McGurran. Please select the correct area so that support reaches those it is intended for. We trust your honesty, thank you.

Additional Information

Help us understand your needs

These questions support safeguarding, monitoring, and evaluation for funders.

Have you attended a community wellbeing programme before? *

Yes

No

Do you have any health conditions we should be aware of?(Optional)

Terms & Consent

Please review and agree to continue

I understand that this is an 8-week community wellbeing programme and agree to attend weekly sessions as consistently as possible. *

I consent to being added to the Eat Well Basildon WhatsApp group for updates. *

I prefer email only *

Photography Consent(Optional)

Roar Through Art CIC sometimes takes photos for community reporting. Do you consent?

Yes, I consent

No, I prefer not to be included

A message from Cllr Aidan McGurran

EAT WELL BASILDON

Official Registration Form

Personal Details

Area Selection

Additional Information

Terms & Consent