Well-Fed Self-Referral

The Well Fed Riverside project is for Riverside customers only, living within the Colshaw Farm and Langley Neighbourhoods. Completing this expression of interest will not guarantee you a place on the programme. Names will be selected at random.

Well Fed - Self Referral

Full name * REQUIRED
* REQUIRED
Address Postcode
Phone number * REQUIRED
Email address * REQUIRED
Confirm email address * REQUIRED
How would you like us to contact you? * REQUIRED
- Email
- Phone
Best time to reach you? * REQUIRED
- AM
- PM
How will the Well-Fed Programme Help You? * REQUIRED
Where did you hear about the Well-Fed programme? * REQUIRED
Please select which part of the programme you are interested in? * REQUIRED
If you have chosen the Meal Box service, please tick to confirm you are happy to take part in the Meal Box 12-week service * REQUIRED
- I am happy to take part
If you are not selected to participate in the Meal Box Programme, would you be interested in the Slow Cooker Programme? * REQUIRED
- Yes
- No
Consent * REQUIRED
Riverside have partnered with leading food charity Well Fed, who are delivering this programme on behalf of Riverside. By completing and sending this form you are giving permission for Well Fed to contact you by phone, text or email. Thank you for taking the time to complete this form. If you are allocated a place on the programme, a member of the Well Fed Team will be in touch soon.
- I have read and understood Riverside's Privacy Policy
Comments
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Well-Fed Programme

Well Fed - Self Referral

You will need the following details to report a nuisance: