Recovery and Empowerment Group Application

Personal Information

We are sorry but it looks like you are out of area for RISE services, as we are only funded to support people who live in Brighton and Hove. We advise that you call the National Domestic Abuse Helpline for information about services in your area.

I confirm that I have read and understood the RISE Privacy Agreement.

First Name *

Last Name

Date of birth

Day

Month

Year

Address

Address 1

Address 2

Town/City

Post Code

County

Contact Number *

Is it safe to call, text, or leave a voicemail on this number? *

Yes

Sometimes

When is it safe to call you? Please specify days and hours e.g. Mon 9.30 - 12.30, Tues 9.30 - 12.30, Weds 5-7pm *

Email *

Is it safe to email you at this address? *

Yes

Preferred Contact Method (Tick all that apply)

Phone me

Email me