BeConnected – Join us

You can use this form to register as a BeConnected member to attend events. Once you are registered you can book onto events.

If you would like to register your interest in volunteering with the BeConnected project, please use this form instead.

BeConnected - service users

Your name*
First Last
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone*
Email
Are you over the age of 55?*
Are you a SARH Customer?*
Next of Kin (Name and Contact Number)*
Do you own a car?*
If not, how do you plan to travel to events?
What are your interests? Do you have any hobbies? Are there any activities you have always wanted to try?
Please let us know of any long term health conditions and describe your mobility*
Events
Please list any events you may be particularly interested in attending.
Connect: Do you feel part of a community?
1 2 3 4 5 6 7 8 9 10
1- Often feel lonely and isolated, rarely interact with people or groups. Do not feel any sense of belonging to the local community. 10- Attends groups, socialises with others and feels connected to the community
Wellbeing: Do you feel content with your life?
1 2 3 4 5 6 7 8 9 10
1- Lack confidence and motivation, Poor mental and physical wellbeing. Low self esteem and loss of interest in the things around me. 10- Feel positive about the future, mentally and physically well. Feeling confident and motivated to engage with the world around me.
Be Active: Do you feel you are as active as you would expect to be for your age?
1 2 3 4 5 6 7 8 9 10
1- Inactive, rarely leave home 10- Regularly take part in social or group activities and feel well. I take good care of my physical and mental health.
CAPTCHA
Consent*
All information will be held in accordance with the General Data Protection Regulation 2018. Your personal data will onl,y be shared with staff employed by SARH. Please tick here to agree.
Comments
This field is for validation purposes and should be left unchanged.

Stafford and Rural Homes

Registered as a Charitable Community Benefit Society 7852
Registered with the Regulator of Social Housing L4458 + VAT number: 135524133
Registered Office: 1 Parker Court, Staffordshire Technology Park, Beaconside, Stafford, ST18 0WP

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Have you tried our Frequently Asked Questions? See www.sarh.co.uk/faq