There are 4 Contact Forms below, please complete the one that most suits your enquiry.

1: LUNCH CLUB APPLICATION FORM:

If you are interest in attending the Wednesday or Thursday lunch club, please provide the following information. The details will be added to the Lunch Club waiting list and you will be contacted by the Lunch Club Manager when a place is available.

Submitted by: *

• Family Member: Full Name
• Carer: Full Name
• Social Support Worker: Full Name
• Friend: Full Name
• Myself

Email of Submitter

Contact Number of Submitter *

Applicants Details *

First

Last

Full Address Including Postcode *

Contact Number *

Day Choice *

• Wednesday
• Thursday
• Both Days

Transport *

• Own Transport
• Lunch Club Mini Bus (Depending on pick up area and available spaces)

We have two Mini Buses 9 & 11 seaters one covering the Ovenden, Illingworth, Mixenden and Pellon area and the other one covering Siddal, Copley, King Cross and Saville Park area. Unfortunatley our buses do not have capacity for wheelchair transportation. All our Drivers and Escorts are volunteers and are not trained in manual handling therefor assistance for entering or exiting our buses will be minimal but safety is our main priority.

Any Dietary/Allergies/Mobility Issues *

Submit

2: ROOM HIRE BOOKING FORM 2024:

Name *

First

Last

Contact Home: *

Contact Mobile: *

Email *

Your Group Details: *

Dates/Frequency Required – Please see Diary Page for available sessions *

Use of our Equipment: *

• Kitchen Facilities
• Use of Projector,Screen,CD,Video

Terms of Hire: *

• I agree to the following terms:

The enquiry form is to ensure room hire bookings comply with the Charity’s objective to support the aged, less able and those experiencing loneliness in Calderdale. See Centre Information page for costs. If the application is approved a Booking Form will be issued for completion and a F2F meeting arranged. Form Updated April 1st 2024.

Submit

3: GENERAL CONTACT FORM:

Please use this form for any general enquires regarding our centre:

Name *

First

Last

Email *

Comment or Message *

Submit

4: VOLUNTEER CONTACT FORM:

If you are interested in joining our team of volunteers at our Lunch Club, Please fill in the form below.

Name *

First

Last

Address & Postcode *

Date of Birth *

Contact Telephone Number *

Email *

Any Previous Volunteering Experience *

Any Relvant Qualification *

Are you available for Charity Events we run on a Saturday. *

• Yes
• No

Submit

Address Lister Street, Winding Road, Halifax. HX1 1UZ

Tel No.  01422 364691

Email  info@mauricejaggercentre.org