Eid al Adha MealUse this form to book a place for yourself (and if required, another adult and/or children). Professionals can also use this form to make a booking on behalf of a client. - Step 1 of 4Data Protection and Confidentiality *I confirmI understand that the information given on this form will be used and stored in line with UKeffโs data protection policy that follows UK General Data Protection Regulation May 2018, more details of which can be found at https://www.ukeff.org/privacy-policy/ UKeff is committed to equal opportunities and seeks to assist individuals from all sectors of the community. UKeff will not tolerate the less favourable treatment of anyone on the grounds of their gender, age, race, colour, nationality, ethnic or national origin, disability, marital status, sexual orientation, responsibility for dependents, trade union or political activities, religious or other beliefs, or any other reason which cannot be shown to be justified. This policy is subject to the requirements and legislative framework as outlined in the Equality Act 2010. Are you completing this form on behalf of another person? *Yes - it's for someone elseNo - it's for meReferrer Name *FirstLastAgency Name and Address *Referrer Phone Number *Please enter your contact phone numberReferrer Email *EmailConfirm EmailReason for Referral *Homeless/rough sleeperDomestic abuseFinancial hardshipOther Please select all that apply Details of referral *Please add the relevant details for your referralAny other support required?Please detail any other required support for the Service UserCheckboxes *I confirmBy signing this form you are confirming that the Client is aware of, and consents to, this referral and that we (UKeff) can share all information contained in this form with the Client. The Client also consents for us to contact them directly to offer support and assistance and to maintain future contact with the referrer if the need arises. I understand that the information given on this form will be used and stored in line with UKeffโs data protection policy that follows UK General Data Protection Regulation May 2018, more details of which can be found at https://www.ukeff.org/privacy-policy/ UKeff is committed to equal opportunities and seeks to assist individuals from all sectors of the community. UKeff will not tolerate the less favourable treatment of anyone on the grounds of their gender, age, race, colour, nationality, ethnic or national origin, disability, marital status, sexual orientation, responsibility for dependents, trade union or political activities, religious or other beliefs, or any other reason which cannot be shown to be justified. This policy is subject to the requirements and legislative framework as outlined in the Equality Act 2010. NextDetails of AdultThere will be space on the next page to add the details of your partner and/or child/children, if neededName *FirstLastAddress *Address Line 1CityState / Province / RegionPostal CodeIf roughsleeper or homeless, please provide hostel details or other contact pointMobile Phone NumberEmail Address *EmailConfirm EmailGender *MaleFemaleDate of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PreviousNextOther AdultsWill any other adults be attending with you? *YesNoPlease select yes if you will be attending as a couple or with an adult relative or friend.Name of 2nd adult *FirstLastWhy do we ask for this detail? So we can keep a register of people who have booked a place.Gender of 2nd adult *MaleFemaleDate of Birth of 2nd adult *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you live at the same address? *YesNoPlease select yes if you live in the same home.Address of 2nd adult *ChildrenWill any children be attending with you? *YesNoName of Child 1 *FirstLastWhy do we ask for this detail? So we can keep a register of people who have booked a place.Date of Birth *DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of Child 2FirstLastLeave blank if no more children.Date of Birth DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of Child 3FirstLastLeave blank if no more children.Date of Birth DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of Child 4FirstLastLeave blank if no more children.Date of Birth DD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PreviousNextAdditional NeedsDo you (or any of your group) have any dietary requirements, allergies or medical conditions? (please give details of medication required and if it can be self-administered) *WebsiteSubmit