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Golden Memories
1. PARTICIPANT INFORMATION
Full Name
*
Age
*
Gender
*
A
Female
B
Male
Phone Number
*
Residential Area / Address
*
2. ATTENDANCE & SUPPORT
Will you attend Golden Memories: Art, Laughter & Legacy?
*
A
Yes
B
No
C
Not sure
Who will you be attending with?
*
A
Alone
B
Family member
C
Friend
D
Caregiver
E
Other
Did you attend last year's Ageing and Smiling Event?
*
A
Yes
B
No
Do you require any accessibility or mobility assistance?
*
A
No
B
Yes
If yes, please briefly describe the assistance needed.
*
3. INTERESTS & ACTIVITIES
Which activities would you most enjoy?
*
Ludo
Ayo
Whot
Other traditional board games
Art & drawing
Music & singing
Storytelling & memory sharing
Which traditional game did you enjoy most when you were younger?
*
4. HEALTH SCREENING
Would you like to participate in the basic health screening available at the event?
*
A
Yes
B
No
Do you have any immediate health or accessibility consideration the event team should be aware of?
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
5. EVENT EXPERIENCE
What are you most looking forward to at the event?
*
Would you be interested in future Ageing & Smiling programmes?
*
A
Yes
B
No
C
Maybe
6. CONSENT
I confirm that the information provided is accurate.
*
Yes, I confirm
I consent to participating in the event activities.
*
Yes, I consent
I consent to participating in the basic health screening.
*
Yes, I consent
No, I do not consent
I understand that photographs/videos may be taken during the event for programme documentation and promotional purposes.
*
A
Yes, I consent
B
No, I do not consent
Submit
