DAVE Registration

Please only use this form if it is safe for you to receive emails. If it is not safe for you to receive emails then please telephone us and we will register you over the phone.

If you have any problems with the registration form below please call us on 01233 680160.

If you register with Dads Unlimited you agree to be bound by our privacy policy.

WE ARE TEMPORARILY NOT ACCEPTING ANY NEW REFERRALS / REGISTRATIONS BECAUSE WE ARE EXPERIENCING EXCEPTIONALLY HIGH DEMAND FOR OUR SERVICES.

THIS IS CONSTANTLY BEING REVIEWED; AND WE APOLOGISE FOR ANY INCONVENIENCE.

 

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?	-Not answered- No Yes
Brief subject
Brief description of issues faced
How did you hear about this service?	Not answered Cafcass CAMHS / CYPMHS Citizens Advice Court Counsellor DAVE Early Help Event Flyer GP/Health Professional Internet search Job Centre Legal Professional Media (TV/Radio/Press) Mediator National Stalking Helpline Oasis Police Professional Referral Rising Sun School Social Services Social Media Victim Support Word of mouth Other
Can we add you to our mailing list?	Not answered Yes No
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	Not answered Cohabiting with ex On own Shared housing With friends With family With new partner Homeless Other
Employment status	Not answered Not employed Part-time employed Full-time employed Self-employed Carer Retired
Currently instructing solicitor or barrister	Yes No DU Barrister Service
Have any Court proceedings already commenced?	Not applicable Yes No
Which other services have been involved?	Not answered None Addiction Support Cafcass Counselling Early Help Mediation Social Services GP or Hospital Home-Start Housing Support Mental Health Services National Stalking Helpline Oasis Police Rising Sun Other Domestic Abuse Service Victim Support
Have you abused alcohol, drugs, or gambling?	-Not answered- No - None Yes - Illegal drugs - in the last three months Yes - Illegal drugs - previously more than 3 months ago Yes - Abused alcohol - in the last three months Yes - Abused alcohol - previously more than 3 months Yes - Gambling - in the last 3 months Yes - Gambling - previously more than 3 months
Are you the victim of domestic abuse?	Not answered No Yes Yes - currently at risk of harm Not sure
Did you report domestic abuse to the Police?	Not applicable Yes No
Are you in debt?	Not answered No Yes - between £0 and £5000 Yes - between £5001 and £10000 Yes - between £10001 and £15000 Yes - between £15001 and £20000 Yes - more than £20000
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