Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Eligibility *

You can check if you might be eligible for one-to-one befriending before applying. If you have not already done so, please make sure to read the FAQ information about one-to-one befriending, on our members page.

I confirm that I have read the FAQ information about one-to-one befriending.

Confirmation *

Please tick to confirm your information is accurate.

I confirm that the information provided in this form is up to date and accurate, to the best of my knowledge.

Your contact details and privacy *

Before submitting this form, you must click the checkbox below. This tells us that you agree that your information entered here, may be used by The Befriending Scheme to contact you in future. To find out more about how we use your data, you can click here to read our full privacy policy.

I agree that my information entered here, may be used by The Befriending Scheme to contact me in future.