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Registration Form

This application is strictly in line with the charities privacy policy.

All information collected will not be shared with any organisation and will be kept solely for ANAM CARA's evaluations and statistics.

No personal data will be shared at any stage during the process and all personal data will be destroyed within a year.

Applicants must fit within the criteria; women who are;

  • Currently experiencing stress, anxiety, depression or low self worth

  • At risk of or are using unhealthy coping mechanisms like alcohol, prescription drugs, food or self harming

  • Are in a stable place to commit to the programme

  • Willing to commit to change.


If you experience any trouble with our registration form, please do not worry! Please call or email one of our fantastic team members who would be delighted to help you.

Julie Surgeon

07551 406 942

Please answer the below questions generally, no amount of detail is required at this stage.

Please choose one option for each answer unless otherwise stated


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