Which event would you like to attend?

Events*

Select event Tuesday 3rd October -Birstall Coffee Morning 10 am until 11.30 am at The Methodist Church, Chapel Lane, Birstall Tuesday 7th October - Huddersfield Coffee Morning 10.30 am until 12 noon at The George Hotel, Huddersfield Thursday 9th October, First Aid Course, 10 am until 12 noon at Gateway to Care, Huddersfield * Wednesday 15th October-, Moving and Handling Training, Almondbury, Huddersfield * Thursday 16th October - Holmfirth Coffee Afternoon 1.30 pm until 3 pm at The Old Bridge Hotel, Holmfirth Tuesday 21st October - Huddersfield Coffee Afternoon 1.30 pm until 3 pm at Gateway to Care, Huddersfield Tuesday 28th October - Creative Writing, 10.30 am until 12 noon at Gateway to Care, Huddersfield. Thursday 30th October - Batley Coffee Morning 9.30 am until 11.30 am Batley Resource Centre, 90 Commercial Street, Batley Thursday 30th October, Looking after Me Course for carers 10.00 am until 12.30 pm ( 7 week course) at Gateway to Care, Huddersfield.* (If an event is full, names will be added to the waiting list.) (Events marked * need to be booked through Carers Gateway)

Your details

Title (Mr, Mrs, Ms, Dr etc)
First Name*
Last name*

Contact address

House number and street name*
Area
Town
Postcode*

Contact details

Telephone number (including area code)
Email address

About you and the person you care for

Your age	0-17yrs 18-64yrs 65+yrs
Your ethnicity
Recipient of care's age	0-17yrs 18-64yrs 65+yrs
Recipient's ethnicity
What disabilities or illnesses does the person you care for have? Learning difficulty Physical disability Mental health Older person Other (Please give details)

Your requirements

Do you require care cover? [Yes] [No]
Do you or the care recipent have any special dietary requirements? (Please tell us about them)

Thank you for your booking - we will send you an acknowledgement.  Please select 'Send Form' below to send your details.