Communitea

Join us for Afternoon Tea with a little more excitement!

Communitea sessions offer an inter-generational space for local resident to socialise and build relationships.

Come along to enjoy:

• Chair exercise
• Tea party lunch
• Games
• Sing -a-longs
• Bingo
• Crafts

Upcoming sessions:

• Tuesday 24^th September 2024
• Tuesday 15^th October 2024
• Tuesday 19^th November 2024
• Tuesday 17^th December 2024

Location: Juniper House, Forth Avenue, W10 4QX

Name *

First

Last

Please provide the a name of Parent or Guardian if under 16 years old

Email *

Please provide the email of a Parent or Guardian if under 16 years old

Contact Number *

Postcode *

Please provide a postcode- your registration cannot be confirmed without it.

For what activity are you registering? *

• Wellbeing Wednesday
• Carers' Time for Self
• Communitea

How would you describe your overall Physical health? *

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

1 - Very Poor | 2 - Poor | 3 - Fair | 4 - Good | 5 - Very Good

How often do you engage in physical activity (e.g., walking, jogging, sports, etc.)? *

• Daily
• A few times a week
• Once a week
• Rarely
• Never

Do you currently experience any of the following? (Select all that apply) *

• hronic pain (e.g., back pain, joint pain)
• Difficulty with mobility or flexibility
• Heart-related issues
• Poster ( lampost or noticeboard)
• Respiratory issues
• No significant health concerns

How would you describe your overall mental wellbeing in the past month? *

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

1 - Very Poor | 2 - Poor | 3 - Fair | 4 - Good | 5 - Very Good

How often do you feel stressed or anxious? *

• Daily
• A few times a week
• Occasionally
• Rarely
• Never

How would you describe your quality of sleep? *

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

1 - Very Poor | 2 - Poor | 3 - Fair | 4 - Good | 5 - Very Good

How often do you participate in social activities or spend time with friends/family? *

• Daily
• A few times a week
• Once a week
• Rarely
• Never

What is your primary reason for participating in the programme. (Select One) *

• Improve Physical Health
• Improve Mental Wellbeing
• Increase social interactions
• Learn new skiils
• Other

If other, please specify *

What do you hope to achieve by participating in this programme? *

How did you hear about this activity? *

• QPCC E-bulletin, Website or Social Media
• Poster (lampost or elsewhere)
• Flyer
• Community Champions
• Other

I would like to *

• To receive QPCC's monthly e-bulletin with information about local news, events and services.
• To receive notices about Public Meeting of the Community Council
• To learn more about volunteering with the Community Council
• None of the above

Photo consent *

• I undertand, that photos and videos will be taken at this event and that by attending, I give permission to QPCC and partners to use any images/videos, reproduction or adaptations of images/videos captured of me for fundraising, publicity or other purposes to help achieve the group’s aims. This might include (but is not limited to), printed and online publicity, social media, press releases and funding applications.

Submit Registration Request