Client Registration Confirm your place on the 2026 Counselling Sponsorship Scheme. Your details First Name Last Name Address line 1 (door number) Street Name City Post Code Mobile Email Date of Birth Emergency contact Emergency Contact Name Relationship to you Emergency contact phone number Your GP GP Name GP Practice Name GP Practice Address GP Phone Number Confirming your place Accept Scheme Place Yes, I accept my place No, I am no longer interested Information Sheet Confirmed Yes, I have read it No, not yet I have a question about the scheme Questions or Comments Agreements and consentPlease read each line carefully before continuing. Agreement Accepted I understand missing two consecutive sessions without notice may result in removal and a £90 penalty I agree to complete a wellbeing evaluation on completing my sessions I agree to take part in additional data collection requested by TMAF, funders or regulators I consent to my personal information being collected and stored by TMAF to administer the counselling scheme I consent to my sessions being recorded for supervision purposes only (not stored by TMAF, not shared beyond supervision) I consent to anonymised information from my case being used for training purposes Staying in touch Marketing Updates Opt-In Yes No Follow-up Contact Consent Yes No
