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Would you like to request our service?


We tackle social isolation in the North Berwick Coastal Ward. Our services include Scone Café, befriending, chumming to new activities, Coffee Connections meet-ups, Buddy Walks, monthly Community Connections newsletter.

Once we receive your form, we’ll get in touch as soon as we can to talk this over.

All confidential details will be stored according to GDPR regulations and under our Safeguarding Policy (available on request) and shared only where consent is given.

For further information or help with completion of form, please call Project Manager Carol Stobie on 07940 203380 (Tuesday to Thursday 8.30am to 4pm).

    * DENOTES REQUIRED FIELDS

    1. YOUR DETAILS

    Name

    Address

    Contact Info

    Date of Birth

    Emergency Contact (if they have given consent)

    Relationship

    Telephone number/s


    2. HEALTH ISSUES AND CONTACTS

    Your answers to these questions may help us determine which services or volunteers would be most helpful, or whether we are the best service to help you.

    Doctor (Name, Address and Telephone No.)

    Do you have any physical or mental health issues that we should be aware of? How does this affect your everyday life?


    3. WHAT BENEFITS DO YOU HOPE TO GAIN FROM INVOLVEMENT WITH COMMUNITY CONNECTIONS?


    4. WHICH COMMUNITY CONNECTIONS SERVICE/S ARE YOU INTERESTED IN? PLEASE TICK.

    Scone Café (weekly drop-in gathering) YES

    Coffee Connections meet-ups with other members YES

    Chumming to one or more local activities, making initial introductions YES

    Befriending (weekly calls or coffee meet ups) YES

    Buddy Walks (one or more walks tailored to needs, with trained volunteer) YES

    Receive monthly Community Connections newsletter YES


    5. IS THERE ANYTHING ELSE WE SHOULD KNOW THAT MIGHT HELP US MEET YOUR NEEDS?


    Date

    Signature


    * DENOTES REQUIRED FIELDS

    For further information or help with completion of form, please call Project Manager Carol Stobie on 07940 203380 (Tuesday to Thursday 8.30am to 4pm).

    All confidential details will be stored according to GDPR regulations and under our Safeguarding Policy (available on request) and shared only where consent is given.