Sign up form Age Better in Sheffield is a project which provides old in. Whether you want to volunteer, opportunities for people over 50 in Sheffield to participate in activities or receive support, live their lives to the full. It is also a research there are lots of ways you can get involved. project to understand what works to reduce Complete this form now and send it to Age loneliness and social isolation. Together we can Better in Sheffield to join the thousands of make Sheffield a city we are all proud to grow people who are already involved. Which Age Better in Sheffield project would you like to apply to be involved with? Please tick one project in the first list at this stage, you can be involved in other projects later on. If you are not sure, tick here if you would like us to phone you to talk through your options. The Ripple Effect Bereavement support for people over 50, delivered in Beauchief and Greenhill ward. Well-being Individual and group counselling for people over 50, including practitioners counselling in the home, delivered in Beauchief and Greenhill, Woodhouse, Burngreave and Firth Park wards. Start Up Support and up to £200 for people over 50 to start up their own activity, delivered in Burngreave, Firth Park, Woodhouse and Beauchief and Greenhill wards. Better Journeys Travel advice and support for people over 50 living in the Firth Park ward. Live Better, A community based service for people over 50 living in Beauchief and Get Connected Greenhill ward who find financial hardship to be a barrier to accessing health and wellbeing support and advice. A Better Life Support for people over 50 in Burngreave ward to improve their financial situation. If you are over 50 and would like to be involved in work to make Sheffield anAge Friendly City, to create or attend more local and citywide events, or to find out about our peer researcher programme, sign up here to find out more. Sparks Get involved with or notified about local and citywide events. Age Friendly Get involved with helping Sheffield to become an Age Friendly city. Peer research Learn how to carry out interviews, focus groups and observations and help us learn about loneliness and how Age Better is working. About you Name and title: Date of birth: Address: Telephone: Mobile: Postcode: Email: Please tick your preferred means of contact? Phone Email Post Text Do you need support with reading or writing? Difficulty reading No difficulty Difficulty reading and writing No English reading or writing skills Difficulty writing Translation services required Limited English reading or writing Prefer not to say What languages do you speak? Is there anything else that you would like to tell us (this includes any special access requirements or risks)? How did you find out about Age Better? Please tick ALL options that apply Self-referral Via project staff GP From a volunteer Adult care or social services From another Age Better including community support intervention workers From SYHA staff or volunteer Another organisation Website Sheltered accomodations or Pharmacist residential care home Other (please specify) Friend or family Leaflet or poster Neighbourhood toolkit Sharing information agreement Your involvement with Age Better in Sheffield is of a confidential nature and information you share with us will normally be kept within the programme and only given to others with your permission. However, information may be shared with the relevant statutory authorities without permission in the following circumstances: • If we are required to do so by law • If there is risk of significant harm to you and/or someone else • If there are child/adult protection concerns I agree for South Yorkshire Housing Association to hold and use Yes No my personal information to take part in the Age Better in Sheffield programme until June 2022. I agree for South Yorkshire Housing Association to share my details Yes No with partner organisations delivering Age Better in Sheffield projects in order to take part in the project(s) I have applied to join You may withdraw your consent and/or ask for your information to be deleted at any time by contacting the Age Better in Sheffield team on: [email protected] or by calling 0114 2900 294. Signature of applicant: Date: Please tick this box to confirm you agree if completing this form Yes No electronically. Referrer information Only complete this section if you are completing this form on behalf of another person. Who are you completing this form for? For someone I support in a For a friend or family member professional capacity If you are completing this for someone else, do they give permission Yes No for you to share further information with Age Better in Sheffield and our delivery partners? If you are completing this for someone else, do you wish to be updated Yes No on their progress and do they grant permission? If you are completing this for someone else, please let us know your name and details: Name and title: Organisation and contact details: ABiS use only: Client ID number: Tel: 0114 290 0294 Email: [email protected] SYHA, 43-47 Wellington Street, Sheffield, S1 4HF www.agebettersheff.co.uk.