7 Steps to Health Course

Please note that only 1 form to be completed and this should be completed by the person with the cancer diagnosis. Terms and conditions apply. These can be found on the website. We advise you read these prior to completing this form. A copy of our terms and conditions will also be sent in receipt of your application.  

Confirmation*
  • I have had a cancer diagnosis
Age.*
Date of Diagnosis
  • Less than 1 year
  • Less than 2 years
  • Less than 3 years
  • Less than 4 years
  • Greater than 5 years
Gender.*
  • Male
  • Female
Have you ever attended a similar course?*
  • Yes
  • No

Contact Information

Country
State / Province*
Address
City
Email*
Confirm Email*
Phone
Health issues
Dietery requirements
Name of supporter if applicable (please note that if bringing a supporter you will be required to share a room)

If your supporter has any dietry requirements or a different emergency contact can you please ensure that this information is included in the comments section at the bottom of the form.

Special requirements eg ground floor bedroom?

Emergency Contact

Name *
Tel:*
Mobile:

General Data Protection Regulation

By choosing my preferences below, I understand that my data and information can be held, accessed and processed by Rainbow Valley for the purposes of evaluation and research. I further understand that all personal data or information I provide to Rainbow Valley will be kept confidential and that no identifiable personal data will be published, presented or shared with a third party, or made public, without my express consent. Information held and processed by Rainbow Valley is in accordance with the General Data Protection Regulation requirements. We will not give out data about you to third parties for marketing purposes. Your details will only be used by Rainbow Valley. We would also like to keep you up-to-date with our upcoming events and courses. Please choose your preferred method of communication below. We only use your emergency contact details if required. We do not contact them with our news or events.

Please note that we need you to consent to email to allow us to inform you about your place on the course and with information on the run up to the date chosen. Due to the nature of the course we regularly have cancelations therefore it is normal practice for us to also phone to confirm your place. If you do not wish for us to phone you please do not leave your number. Without your consent we are unable to process your request of place on our 7 Steps to Health course. You are able to opt out an any time following the course by emailing info@rainbowvalley.org.uk.

You can opt out of our database at any time by emailing info@rainbowvalley.org.uk.

Terms and Conditions

By submitting this form you are confirming that you have read and understood Rainbow Valley’s terms and conditions and that the information you have provided is accurate.

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