Course Enrolment Form (Self-Referral)

We are delighted that you are interested in taking part in a creative course. The questions below are designed to ensure that we can make you feel as safe, welcome, and comfortable on the course as possible, to ensure that we can meet your needs and for you to give your consent and permissions as you see fit.

Please read through our Participation Criteria to ensure that our courses are appropriate for your needs.

If you need any support in completing this form or have any questions about the form, the creative course you are interested in or the Well-City Salisbury project generally, please get in touch with our Project Coordinator, Zoe , via email: You can also get in touch on 07707 296883 Monday-Thursday.

How to Complete this Form

Please complete all sections of the form. If you need support in filling in the form our Project Coordinator is happy to help or you can get a friend, family member or someone in a professional support role to assist you.

Once all the sections are filled in, please return it to the Project Coordinator by clicking submit at the bottom of the form/page.

    A. Applicant's personal details

    B. Applicant's Medical and Health Information

    Well-City Salisbury creative courses involve fine motor skills, such as using a pencil, and some may involve physical activity, such as walking. We will always seek to support the individual needs of participants where possible and it would be helpful for us to know the nature of any mental health needs (such as depression, anxiety etc.) and physical health needs (such as diabetes, mobility issues etc.) you may have.

    Please note: Well-City Salisbury staff are not clinically trained and cannot administer any medication. The participant is responsible, at all times, for any medication and ensuring this has been taken as needed.

    C. Identified Support Person

    Please identify an individual in a professional capacity – mentor, community group leader, support worker etc. (not a family member or friend) – with whom you feel comfortable talking to should you require support. Ensure you let this person know that you have given their name and that they are happy to be named as a support person. If you are struggling to identify someone, please get in touch with the Project Coordinator to discuss options.

    D. Previous Participation

    (Please skip if this is your first application to take part in a Well-City Salisbury course)

    E. Applicant's Consent

    Well-City Salisbury take our responsibility for looking after your personal information seriously. We follow data protection legislation when asking for or handling your information.

    The information requested on this form is to enable us to fulfil the requirements of the project, ensures that we can contact you, take account of your health and safety, record your volunteering/activity and are able to undertake reporting on the project’s effectiveness. Your personal details will:

    • Be kept secure and only accessed by those involved with the Well-City Salisbury project
    • Be kept confidential and will not be released to third parties without your consent
    • Be anonymised when reporting on the project and for analysis to help us improve our service, unless you tell us you are happy for your name to be used
    • Be kept for the duration of the project (until Dec 2024) at which point they will be deleted

    You can find out more information about the individual Project Partners privacy policies and your rights related to GDPR and DPA here:

    On occasion you might be asked to complete a range of evaluation documents and give feedback verbally as part of a group. If we ask you to do this then the following things will happen with your information:

    By signing this application, you are confirming that you understand that your details will be kept on the Well-City Salisbury database and used for evaluation purposes in accordance with the above data protection statements and agree to the following:

    Communication Permission

    I give permission for the following to get in touch with me after the completion of my creative course in relation to further activities and events that might be of interest to me (please tick to opt in):

    Photo/Media Permission

    I confirm my consent allowing the Well-City Salisbury project and the Project Partners (ArtCare, The Salisbury Museum, Wessex Archaeology and Wiltshire Creative) to take...

    ...of me in relation to participating in creative courses and to use pictures, video and recordings of my voice for the purposes of promoting the project, reporting to funders, developing project resources (both hardcopy and digital) and celebrating the project through events such as exhibitions.

    I agree for the above selected to be used in the following ways (please tick to agree):

    I agree my name can be published together with photos, videos, and audio of me.

    I agree my name can be published together with written transcription of my verbal feedback.