Contact Us

Enquiry Form

Call us on: 01482 871993 / Email us at reception@ctca.org.uk / Alternatively use the form below to contact us and state what you would like to contact us about from the drop down list.

The Centre is open 9am-12pm Monday, 9am-4pm Tuesday, 9am-5pm Thursday and 9am-2pm Friday. We are closed on Wednesdays and on Weekends. If we do not answer the phone straight away please leave a message our phone lines are always busy.

Name:

Email:

Phone:

I'm looking for help with:

Address:

How did you hear about us?

Message:

Before we can assist you, please fill in the Form Of Authority section below

THIS FORM CANNOT BE COMPLETED ON BEHALF OF A THIRD PARTY

Client's Name:

Postcode:

Date of Birth:

Address:

Telephone Number:

N.I Number:

In order to help you we need to store information about you. The law says we must get your consent to do this. Everything you tell me will be treated confidentially.

By signing this form you are allowing me to act on your behalf, to make enquires, receive and store information regarding your affairs and receive medical evidence relating to you.

Please see our Privacy Policy for further clarification.

Please confirm:

I authorise the Beverley Cherry Tree Community Centre to act on my behalf

Date:

We are subject to external audits and your file may be reviewed by auditors.

Please confirm:

Please confirm to give authority for them to review your file

Date: