Registered Charity No. 1182698

Family Registration Form

Please complete this form to register your family with Hand in Hand. All information is kept strictly confidential.

Family Details

Title *

First Name *

Last Name *

Address *

City *

Postcode *

Email *

Mobile *

Landline

Date of Birth

How did you hear about Hand in Hand? *

Is this your first contact with Hand in Hand? *

Spouse/Partner

Title

First Name

Last Name

Date of Birth

Mobile

Emergency Contact

Name *

Relationship *

Telephone *

Rabbi Reference

Due to safeguarding regulations, we will be contacting your Rabbi as a reference.

Name *

Telephone *

Shul/Congregation *

Family Members in Household

Employment and Housing

Occupation *

Full/Part Time *

Spouse Occupation

Spouse Full/Part Time

Type of Housing *

Assistance by Other Organisations

Currently being assisted by other agencies

Receiving benefits

Medical

Any factors relevant to you or a family member?

Assistance Requested

Why are you requesting assistance? (Select all that apply) *

Details

What assistance would you benefit from?

Playing with Children Taking out child with special needs Homework Help Supper time Holding Baby Visiting Elderly Other

Thank you for contacting us. The Head of Family Services will be in touch shortly, but if you require advice or further information, please feel free to write to office@hih.org.uk.

Once you have successfully submitted your form you will be sent an automated email with more information and further steps that must be completed. Please check your spam folder if it does not appear in your inbox shortly.