Thank you for making contact. In order to help you, we need you to register below. All field are compulsory and must be completed.

By completing this form, you agree to our privacy policy: We will receive the information you have provided and this will be stored securely within our case management system. Only authorised Mentors will have access to your information. We will hold this information for up to 16 years. You can request to have your information deleted at any time – please contact us on 01233 680151 for more information about your data.


Support Registration
First Name  
Surname  
Name of person filling out form  
Email Address  
Phone  
Home Address: House name or number and street name  
Home address: Postcode  
Have you had suicidal thoughts?   
Brief subject  
Brief description of issues faced   
Current child arrangements   
How did you hear about Dads Unlimited?   
Can we add you to our mailing list?   
How many children do you have?  
Child 1 age?  
Child 1 schools name?  
Child 2 age?  
Child 2 schools name?  
Child 3 age?  
Child 3 schools name?  
Child 4 age?  
Child 4 schools name?  
Your current living arrangements   
Employment status   
Have you ever served in the Armed Forces/Reserves?   
Currently instructing solicitor or barrister   
Have any Court proceedings already commenced?   
Have the Police and Social Services been involved?   
Any Convictions Cautions Warnings Reprimands?   
Taken illegal drugs or abused alcohol?   
Have you been the victim of domestic abuse?   
Did you report Domestic Abuse to the Police?   
If you did not report DA to the Police - Why?   
Have you been a victim of other crimes previously?   
   
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