York Safe Space Scheme Registration Form

York Safe Place Scheme Registration Form

This form asks for contact information that will help us to provide Safe Places in York. You can get in touch with us at safeplaces@yorkkcvs.org.uk or by calling 01904 621133 if you need any help completing it.

Safe Place Card holder details
Name:*
Address:*
Email:
Telephone number:*
Emergency Contact Details
Name of emergency contact one:*
The contact details of someone who you trust who has given their permission to be contacted in an emergency
Telephone number of emergency contact one:*
The telephone number of someone you trust who has given you their permission to contact them in an emergency
Name of emergency contact two:
The contact details of someone who you trust who has given their permission to be contacted in an emergency
Telephone number of emergency contact two:
The telephone number of someone you trust who has given you their permission to contact them in an emergency
Staying in touch
Would you like us to email you updates about new Safe Places in York?*
Why would it help you to have a Safe Places card?
Would you be willing to tell us about your experience using Safe Places?
Keeping your data safe
We care about your data. We only use your data with your permission to help you access Safe Places support, and we keep it secure. We never share your data with third parties unless you tell us we can. Any contact information you provide is only used to keep you informed about the Safe Place scheme and to provide you with a membership card. If at any time you wish to remove your data from our database, please let us know and we will delete this from our records. You can unsubscribe from the Safe Places mailing list by contacting us or clicking the unsubscribe button. To read our privacy statement, go to https://www.yorkcvs.org.uk/york-cvs-privacy-notice/