Women's Service Registration Form
Identity
Forename
Surname
Date Of Birth
Day
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
Address
Address 1
Address 2
Town
County
Post Code
Contact
Tel no:home
Tel no: work
Mobile
Email
Emergency contact details
Emergency Contact 1 - First Name
Emergency Contact 1 - Last Name
Emergency Contact 1 - Tel no: home
Emergency Contact 1 - Tel no: work
Emergency Contact 1 - Tel no: mobile
Emergency Contact 1 - Email
Emergency Contact 1 - Relationship
Emergency Contact 2 - First Name
Emergency Contact 2 - Last Name
Emergency Contact 2 - Tel no.
Emergency Contact 2 - Email
Emergency Contact 2 - Relationship
Health, Wellbeing and Access Needs
Specific requirements relevant to accessing our service (Please tell us about any access or support requirements you have while attending our service. This includes any support you may need in the event of an emergency evacuation (for example, help using stairs or hearing the fire alarm):
None
Limited mobility
Hearing support needs
Vision support needs
Other
Please specify your other access or support requirements.
Do you have a long-term health condition, disability or ongoing support need?
Please Select
Yes
No
Physical health or mobility needs
Diabetes
Limited mobility
Joint issues - osteoarthritis, back / hip / knee / shoulder pain or other
Vision support needs
Hearing support needs
Breathing difficulties / respiratory disorder - asthma or other
Heart or circulation issues
High blood pressure
Cancer
Other
None
Mental health and emotional wellbeing needs
Anxiety
Low mood / depression
Panic attacks
Obsessive Compulsive Disorder (OCD)
Trauma-related experiences (e.g. Post Traumatic Stress Disorder (PTSD))
Other
None
Learning or neurodiversity needs
Dyslexia
Dyspraxia
ADHD
Autism
Other
None
Dietary requirements/allergies
Is there anything about your health, wellbeing, or support needs that would help us ensure you feel safe, included, and supported while taking part?
Education
Women and Volunteer: Level of education
Please Select
No previous education
Primary education overseas
Secondary education overseas
Professional/Technical qualification overseas
Degree overseas
Post degree overseas
Primary education UK
Secondary education UK
Professional/Technical qualification UK
Degree UK
Post degree UK
Other
Prefer not to say
Name of current school /college
Course studied
Employment
What is your current employment status? (new)
Please Select
Employed – full time
Employed – part time
Employed – hours vary
Employed – multiple jobs
Self – employed
Retired
Maternity leave
Not working – full time parent / carer
Not working – looking for work
Not working – due to health or disability
Not working - no permission to work in the UK
Not working - not looking for paid work
Occupation
Hours of work per week
Please Select
0 - 15 hours
16 - 24 hours
25 - 30 hours
30+
variable hours
Support
Are you or anyone in your household unit receiving any benefits? (select all that apply)
Not receiving any benefits
Carer's Allowance
Child benefit
Emergency children's social care
Disability Living Allowance (DLA) / Personal Independence Payment (PIP)
Employment Support Allowance
Housing Benefit
Income Support
Job Seekers Allowance
Maternity allowance/ Paternity allowance/ Maternity grant
Pension or Pension Credit
Sickness / Invalidity Benefit
Tax Credit
Universal Credit
Other
Prefer not to say
Not available
Demographic
Sex
Please Select
F
M
Civil Status
Please Select
Single
Single parent (child under 18)
Married
In a civil partnership
Separated
Divorced
Widowed
Prefer not to say
Religion
Please Select
Buddhist
Christian: Church of England
Christian: Other denomination
Christian: Roman Catholic
Hindu
Jewish
Muslim
Sikh
Other Religion
No religion or belief
Not requested
Prefer not to say
Nationality (select all that apply)
Afghan
Albanian
Algerian
American
Andorran
Angolan
Anguillan
Antigua and Barbuda, Citizen of
Argentine
Armenian
Australian
Austrian
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bermudian
Bhutanese
Bolivian
Bosnia and Herzegovina, Citizen of
Botswanan
Brazilian
British
British Virgin Islander
Bruneian
Bulgarian
Burkinabe
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Cayman Islander
Central Afrian
Chadian
Chilean
Chinese
Colombian
Comoran
Congelese (Democratic Republic)
Congolese (Congo)
Cook Islander
Costa Rican
Croatian
Cuban
Cymraes
Cymro
Cypriot
Czech
Danish
Djiboutian
Dominican Republic, Citizen of
Dominican
Dutch
East Timorese
Ecuadorian
Egyptian
Emirati
English
Equatorial Guinean
Eritrean
Estonian
Ethiopean
Faroese
Fijian
Filipino
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Gibraltarian
Greek
Greenlandic
Grenadian
Guinea-Bissau, Citizen of
Guamanian
Guatemalan
Guinean
Guyanese
Haitian
Honduran
Hong Konger
Hungarian
Icelandic
Indian
Indonesian
Iranian
Iraqi
Irish
Israeli
Italian
Ivorian
Jamaican
Japanese
Kiribati, Citizen of
Jordanian
Kazakh
Kenyan
Kittitian
Kosovan
Kuwaiti
Kyrgyz
Lao
Liechtenstein, Citizen of
Latvian
Lebanese
Liberian
Libyan
Lithuanian
Luxembourger
Macanese
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Marshallese
Martiniquais
Mauritanian
Mauritian
Mexican
Micronesian
Moldovan
Monegasque
Mongolian
Monserratian
Montenegrin
Morrocan
Mosotho
Mozambican
Namibian
Nauruan
Nepalese
New Zealander
Nicaraguan
Nigerian
Niuean
North Irish
North Korean
Norwegian
Omani
Pakistani
Palauan
Palestinian
Panamaian
Papua New Guinean
Paraguayan
Peruvian
Pitcairn Islander
Polish
Portuguese
Prefer not to say
Prydeinig
Puerto Rican
Qatari
Romanian
Russian
Rwandan
Salvadoran
Sammarinese
Samoan
Sao Tomean
Seychelles, Citizen of
Saudi Arabian
Scottish
Senegalese
Serbian
Sierra Leonean
Singaporean
Slovak
Slovenian
Solomon Islander
Somali
South African
South Korean
South Sudanese
Spanish
Sri Lankan
St Helenian
St Lucian
Stateless
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Taiwanese
Tajik
Tanzanian
Thai
Togolese
Tongan
Trinidadian
Tristanian
Tunisian
Turkish
Turkmen
Turks and Caicos Islander
Vanuatu, Citizen of
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbek
Vatican citizen
Venezuelan
Vietnamese
Vincentian
Wallisian
Welsh
Yemeni
Zambian
Zimbabwean
Not available
Country of birth
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma or Myanmar
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Congo (Democratic Republic)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czechia or Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morroco
Mozambique
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Prefer not to say
Qatar
Romania
Russia
Rwanda
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts and Nevis
St Lucia
St Vincent
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
UAE
UK
USA
Uganda
Ukraine
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
West Indies
Yemen
Zambia
Zimbabwe
Not available
First Language
Please Select
Afrikaans
Akan
Albanian
Amharic
Amhurce
Angaur
Arabic
Armenian
Ashanti
Assamese
Aymara
Azerbaijani Turkic
Badjuni
Bahasa Indonesia (Indonesian)
Bahasa Melayu (Malay)
Bambara
Bangla
Baoule
Basque
Belarusan
Bemba
Bemin
Bengali
Berber
Bilen
Bislama
Bokmål Norwegian
Bosnian
Bulgarian
Burmese
Catalan
Cheeyo
Chewa
Chibarwe
Chichewa
Chinese, Cantonese
Chinese, Mandarin
Creole
Criuolo
Croatian
Czech
Dagomba
Danish
Dari Persian
Dionla
Dutch
Dzongkha
Edo
English
Estonian
Ewe
Fang
Fanti
Farsi
Fijian
Filipino
Finnish
French
French Patois
Frisian
Fulani
Ga
Galician
Georgian
German
Greek
GuaranÃ
Gujarati
Hassaniya Arabic
Hausa
Hebrew
Hindi
Hiri Motu
Hungarian
I-Kiribati (Gilbertese)
Icelandic
Igbo
Ilocano
Indu
Irish (Gaelic)
Italian
Itsekiri
Jamaican Creole
Japanese
Javanese
Jola
Kabiyé
Kalanga
Kannada
Kaonde
Kashmiri
Kazak
Khmer
Kigisu
Kikongo
Kikuyu
Kimbundu
Kinyarwanda
Kirundi
Koi-san
Korean
Krio
Kurdish
Kyrgyz
Lao
Latin
Latvian
Lingala
Lithuanian
Lozi
Luganda
Lunda
Luo
Luvale
Luxermbourgish
Macedonian
Madura
Malagasy
Malayalam
Maldivian Dhivehi
Malinké
Maltese
Mandingo
Maori
Marathi
Marshallese
Melanesian pidgin
Mina
Mirandese
Moldovan
Mongolian
Montenegrin
Moore
Nambya
Nauruan
Ndau
Nepali
Nigerian
Not available
Nyanja
Nynorsk Norwegian
Oriya
Oromo
Palauan
Pashto
Persian
Peulh
Polish
Portuguese
Prefer not to say
Punjabi
Quechua
Romani
Romanian
Russian
Rusta
Rwandan
Samoan
Sanskrit
Saraiki
Saria
Scots Gaelic
Sepedi
Serbian
Serbo-Croatian
Seselwa Creole
Sesotho
Setswana
Shangani
Shona
Sindhi
Sinhala
Slovak
Slovenian
Somali
Soninke
Sonsoralese
Sotho
Spanish
Sudanese
Surinamese
Swahali
Swedish
Tagalog
Tajik
Tamil
Tehere
Telugu
Termini
Tetum
Thai
Tigrina
Tobi
Tok Pisin
Tongan
Tshivenda
Tswana
Tuareg
Turkish
Turkmen
Tuvaluan
Twi
Ukrainian
Urdu
Urhoboh
Uzbek
Venda
Vietnamese
Welsh
Wobe
Wolof
Xitsonga
Yoruba
isiNdebele (Ndebele)
isiXhosa (Xhosa)
isiZulu (Zulu)
siSwati
Any other languages (select all that apply)
Afrikaans
Akan
Albanian
Amharic
Amhurce
Angaur
Arabic
Armenian
Ashanti
Assamese
Aymara
Azerbaijani Turkic
Badjuni
Bahasa Indonesia (Indonesian)
Bahasa Melayu (Malay)
Bambara
Bangla
Baoule
Basque
Belarusan
Bemba
Bemin
Bengali
Berber
Bilen
Bislama
Bokmål Norwegian
Bosnian
Bulgarian
Burmese
Catalan
Cheeyo
Chewa
Chibarwe
Chichewa
Chinese, Cantonese
Chinese, Mandarin
Creole
Criuolo
Croatian
Czech
Dagomba
Danish
Dari Persian
Dionla
Dutch
Dzongkha
Edo
English
Estonian
Ewe
Fang
Fanti
Farsi
Fijian
Filipino
Finnish
French
French Patois
Frisian
Fulani
Ga
Galician
Georgian
German
Greek
GuaranÃ
Gujarati
Hassaniya Arabic
Hausa
Hebrew
Hindi
Hiri Motu
Hungarian
I-Kiribati (Gilbertese)
Icelandic
Igbo
Ilocano
Indu
Irish (Gaelic)
Italian
Itsekiri
Jamaican Creole
Japanese
Javanese
Jola
Kabiyé
Kalanga
Kannada
Kaonde
Kashmiri
Kazak
Khmer
Kigisu
Kikongo
Kikuyu
Kimbundu
Kinyarwanda
Kirundi
Koi-san
Korean
Krio
Kurdish
Kyrgyz
Lao
Latin
Latvian
Lingala
Lithuanian
Lozi
Luganda
Lunda
Luo
Luvale
Luxermbourgish
Macedonian
Madura
Malagasy
Malayalam
Maldivian Dhivehi
Malinké
Maltese
Mandingo
Maori
Marathi
Marshallese
Melanesian pidgin
Mina
Mirandese
Moldovan
Mongolian
Montenegrin
Moore
Nambya
Nauruan
Ndau
Nepali
Nigerian
Not available
Nyanja
Nynorsk Norwegian
Oriya
Oromo
Palauan
Pashto
Persian
Peulh
Polish
Portuguese
Prefer not to say
Punjabi
Quechua
Romani
Romanian
Russian
Rusta
Rwandan
Samoan
Sanskrit
Saraiki
Saria
Scots Gaelic
Sepedi
Serbian
Serbo-Croatian
Seselwa Creole
Sesotho
Setswana
Shangani
Shona
Sindhi
Sinhala
Slovak
Slovenian
Somali
Soninke
Sonsoralese
Sotho
Spanish
Sudanese
Surinamese
Swahali
Swedish
Tagalog
Tajik
Tamil
Tehere
Telugu
Termini
Tetum
Thai
Tigrina
Tobi
Tok Pisin
Tongan
Tshivenda
Tswana
Tuareg
Turkish
Turkmen
Tuvaluan
Twi
Ukrainian
Urdu
Urhoboh
Uzbek
Venda
Vietnamese
Welsh
Wobe
Wolof
Xitsonga
Yoruba
isiNdebele (Ndebele)
isiXhosa (Xhosa)
isiZulu (Zulu)
siSwati
Ethnicity
Please Select
Arab
Asian: Any other background
Asian: Bangladeshi
Asian: British
Asian: Chinese
Asian: Indian
Asian: Pakistani
Black: African
Black: Any other background
Black: British
Black: Caribbean
Latin American
Mixed Ethnicity: Any other background
Mixed Ethnicity: Caribbean & African
Mixed Ethnicity: White and Asian
Mixed Ethnicity: White and Black African
Mixed Ethnicity: White and Black Caribbean
Other ethnic group
White: British
White: Eastern European
White: European
White: Irish
White: Portugese
White: Any other background
Prefer not to say
Immigration Status
What is your immigration status?
Please Select
Asylum Seeker (Asylum application pending)
British citizen
Child of a British national
Dependant of a British national
EEA (for EU nationals)
EEA Family member (for non-European family members of EU nationals)
Humanitarian Protection
Parent of a British child
Refugee (Asylum application granted)
Settled (Indefinite Leave to Remain/ Settled Status/ Settlement/ Permanent Residence)
Limited leave to remain
Spouse (of British partners)
Student visa (includes general and short-term)
Work visa (only for non-EU, includes Tier 1, Tier 2 and Tier 5 short term worker)
Visitor
Nationality specific limited leave to remain (eg. Ukraine and Hong Kong BNO)
Not available
Prefer not to say
If you were not born here, when did you come to live in this country?
Day
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
Household Unit
Do you have dependents? (select all that apply)
No dependents
Partner
Children
Other family member
Other
Prefer not to say
Do you have caring responsibilities? Please describe.
Number of adults in household (female)
Number of adults in household (male)
Number of children in household (female)
Number of children in household (males)
Housing Situation
Which best describes your housing situation?
Please Select
Owned - Outright
Owned - Mortgage
Rented - Council
Rented - Other social landlord (including housing association)
Rented - Private landlord
Temporary / Emergency accommodation
No fixed address
Refuge
Supported accommodation
Home stay
Other
Prefer not to say
Not available
Women: Which best describes your living situation? (select all that apply)
I live on my own
I live with my partner
I live with my children
I live with other people
Why Baytree?
What attracted you to Baytree? (select all that apply)
Women / Girls only
Local
Daughter attends youth activities
To learn new skills
Affordable
Time of classes / activities
Recommendation
Courses / Activities on offer
Baytree Reach
How did you hear about Baytree? (select all that apply)
Word of mouth
Friends / Family
Website
Social media
Flyer
Passing by
School/College
Partner organisation
Other organisation
Other
Please specify other organisation.
Does a family member attend activities at Baytree? (select all that apply)
No
Mother
Daughter
Other
Privacy and Data Protection
We take your privacy seriously. Our Privacy Statement (on our website or available from staff) explains how we look after your information. When you join our services, we collect and store your details securely. Staff who need it can access this to support you. Your information is kept confidential, except where we must share it (e.g. with social services) if we believe you or someone else is at risk of harm. Under GDPR, you can: (1) ask to see the information we hold about you, (2) ask us to correct or delete it (in some cases), (3) ask us to stop or limit how we use it and (4) withdraw consent if you change your mind If you have concerns, please speak to a staff member or contact the Information Commissioner’s Office (ICO). By accessing our services, you confirm that you consent to the storage and use of your data.
Please Select
Yes
You agree to be contacted by the following methods:
Text/WhatsApp
Email
Media Consent
Do you give Baytree permission to use your image in photographs or films? For example, on our website, on social media, in funder reports, or in research.
Please Select
Yes
No
Submit
