PLEASE COMPLETE. Thank You. Contact Information Name / Please Tickp / Male O Female O

PLEASE COMPLETE. Thank you. Contact Information Male  Name Please tick Female  Address Post Code

Email Address Date of Birth Yes  Contact Do you live alone? Tel No/s Please tick  No 

Emergency Contact 1 Relative/Friend/Neighbour/Doctor

Name Relationship

Contact Tel Email Address No/s Include mobile Emergency Contact 2 Relative/Friend/Neighbour/Doctor

Name Relationship

Contact Tel Email Address No/s Include mobile

Where did you hear about Roar?

ROAR PROJECTS AND SERVICES For more information on times, dates, venues and costs for any of our projects please contact the Roar office on 0141 889 7481. Please tick the project/s or service you are requesting.

Basic toenail cutting and filing service delivered by Roar staff and trained volunteers. Various Roar Do Feet venues throughout Renfrewshire. Cost £12 for 30 min appointment and one off cost of £12 for foot care pack. Falls We are passionate about stopping avoidable falls and injuries. Our trained staff can assess and Prevention offer advice and solutions to help you stay safer and independent longer. Provides gentle exercises designed for older adults to improve your strength and balance which Otago Classes will help to keep you mobile. In various venues throughout Renfrewshire. Exclusive Health & Wellbeing MOT by qualified physiotherapists who will assess your fitness and Well Invested provide specialist exercises. IT Tablet If you don’t have a tablet but want to find out more, or do you have one and want to get better at Classes using it, this informal 6 week course is for you. A chance to see films or programmes chosen by the group and an opportunity for a blether, a Reels & Spiels quiz or discussion as well as a cup of tea. Offers older adults aged 60+ a safe, social and creative environment where they can learn new Craft Cafe skills, renew social networks and reconnect with their communities. This opportunity is for men to come together to enjoy and learn from activities related to topics Men’s Group such as science, technology, history, sport and nature with a monthly outing to various venues. Come Dine An opportunity to plan, prepare, cook meals and then dine together. The group is supported to with Me try new recipes, pick up new cooking tips with an emphasis on having fun and eating well. Information & Stay connected and informed about projects, services and events in your area. Signposting

Roar – Connections for Life is a company limited by guarantee, (Company number: SC390855) and a charity registered in Scotland (Charity Number: SC042041) ROAR HEALTH & WELLBEING CLUBS Roar Clubs for Older Adults provides lunch with a tailored health and wellbeing programme. Please tick  your preferred option. West End Community Centre Houston 5A Underwood Lane, Paisley PA1 2SL Mon Houston & Killellan Kirk Hall, Wed Currently has a waiting list Houston PA6 7EL Johnstone/Elderslie Linwood Elderslie Village Hall, Thurs Tweedie Hall, Bridge Street, Wed Stoddard Square, Elderslie PA5 9AS Linwood PA3 3DB Currently has a waiting list Currently has a waiting list Gallowhill Gallowhill Community Centre, Erskine Bargarran Community Centre Netherhill Road, Paisley PA3 4SF Tue Wed Erskine PA8 6BS (light lunch) Currently has a waiting list Sherwood Greenlaw Church Lochwinnoch Glasgow Road, Paisley PA1 3PA Thurs Tue McKillop Institute, 2 – 4 pm (lunch not provided at this club) Lochwinnoch PA12 4AJ Currently has a waiting list Fri Ralston St Mark’s Church, Ralston, Paisley PA1 3DL - Current Waiting List Closed

BEFRIENDING Befriending is aimed at people who are particularly socially isolated due to life events, low confidence or declining mobility. Our experienced staff assess and design opportunities around the interests and ability of the person. For some people this may be a weekly visit, regular phone calls or for others they may become part of a friendship group. This service is grant funded but capacity is limited. . Assessment for Befriending Please tick if you require this service

Please give details of any relevant health or social concerns

Do you smoke? Please tick  Yes  No  Can you answer the door? Yes  No  Yes  No  Do you have problems with walking/mobility? Yes  No  Can you answer the phone?

PLEASE NOTE: Demand for Roar – Connections for Life’s services are very high but we will try our best to find an opportunity for people who need new connections.

Data Protection Statement The information you provide on this form will be treated in the strictest confidence and will be used only for compliance of the Data Protection Act. We may check the information collected with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect funds, or in other ways as permitted by law. By signing the application form you agree to the processing of personal sensitive data (as described above) in accordance with the Data Protection Act, 1998. I agree to the data protection statement above and I certify that all statements given on this form by me are true and correct to the best of my knowledge.

Signature Date

Please return form to: Roar – Connections for Life, West End Community Centre, 5A Underwood Lane, Paisley PA1 2SL If you require any further information please contact Roar Office on 0141 889 7481 or email [email protected]. Thank You

Roar – Connections for Life is a company limited by guarantee, (Company number: SC390855) and a charity registered in Scotland (Charity Number: SC042041)