Contact Information
Name / Please tickP / Male o Female o
Address / Post Code
Email Address / Date of Birth
Contact
Tel No/s / Do you live alone? Please P / Yes o
No o
Emergency Contact 1 Relative/Friend/Neighbour/Doctor
Name
/ Relationship
Email Address / Contact Tel No/s
Include mobile
Emergency Contact 2 Relative/Friend/Neighbour/Doctor
Name
/ Relationship
Email Address / Contact Tel No/s
Include mobile
Where did you hear about Roar?
ROAR PROJECTS AND SERVICES
For more information on times, dates, venues and costs for any of our projects please contact the Roar office on 0141 889 7481. Please tick Pthe project/s or service you are requesting.
Roar Do Feet / Basic toenail cutting and filing service delivered by Roar staff and trained volunteers. Various venues throughout Renfrewshire. Cost £12 for 30 min appointment and one off cost of £12 for foot care pack.Falls Prevention / We are passionate about stopping avoidable falls and injuries. Our trained staff can assess and offer advice and solutions to help you stay safer and independent longer.
Otago Classes / Provides gentle exercises designed for older adults to improve your strength and balance which will help to keep you mobile. In various venues throughout Renfrewshire.
Well Invested / Exclusive Health & Wellbeing MOT by qualified physiotherapists who will assess your fitness and provide specialist exercises.
IT Tablet
Classes / If you don’t have a tablet but want to find out more, or do you have one and want to get better at using it, this informal 6 week course is for you.
Reels & Spiels / A chance to see films or programmes chosen by the group and an opportunity for a blether, a quiz or discussion as well as a cup of tea.
Craft Cafe / Offers older adults aged 60+ a safe, social and creative environment where they can learn new skills, renew social networks and reconnect with their communities.
Men’s Group / This opportunity is for men to come together to enjoy and learn from activities related to topics such as science, technology, history, sport and nature with a monthly outing to various venues.
Come Dine with Me / An opportunity to plan, prepare, cook meals and then dine together. The group is supported to try new recipes, pick up new cooking tips with an emphasis on having fun and eating well.
Information & Signposting / Stay connected and informed about projects, services and events in your area.
ROAR HEALTH & WELLBEING CLUBS
Roar Clubs for Older Adults provides lunch with a tailored health and wellbeing programme.
Please tick P your preferred option.
5A Underwood Lane, Paisley PA1 2SL
Currently has a waiting list / Mon / Houston
Houston & Killellan Kirk Hall,
Houston PA6 7EL / Wed
Johnstone/Elderslie
Elderslie Village Hall,
Stoddard Square, Elderslie PA5 9AS
Currently has a waiting list / Thurs / Linwood
Tweedie Hall, Bridge Street,
Linwood PA3 3DB
Currently has a waiting list / Wed
Gallowhill Community Centre,
Netherhill Road, Paisley PA3 4SF
Currently has a waiting list / Tue / Erskine Bargarran Community Centre
Erskine PA8 6BS (light lunch) / Wed
Sherwood Greenlaw Church
Glasgow Road, Paisley PA1 3PA
2 – 4 pm (lunch not provided at this club)
Currently has a waiting list / Tue / Lochwinnoch
McKillop Institute,
Lochwinnoch PA12 4AJ / Thurs
Ralston St Mark’s Church, Ralston, Paisley PA1 3DL - Current Waiting List Closed / Fri
BEFRIENDING
Befriending is aimed at people who are particularly socially isolated due to life events, low confidence or declining mobility. Our experienced staff assess and design opportunities around the interests and ability of the person. For some people this may be a weekly visit, regular phone calls or for others they may become part of a friendship group. This service is grant funded but capacity is limited.
Please give details of any relevant health or social concerns
Do you smoke? Please tick P / Yes * No * / Can you answer the door? / Yes * No *
Do you have problems with walking/mobility? / Yes * No * / Can you answer the phone? / Yes * No *
PLEASE NOTE: Demand for Roar – Connections for Life’s services are very high but we will try our best to find an opportunity for people who need new connections.
Data Protection Statement
The information you provide on this form will be treated in the strictest confidence and will be used only for compliance of the Data Protection Act. We may check the information collected with third parties or with other information held by us. We may also use or pass to certain third parties information to prevent or detect crime, to protect funds, or in other ways as permitted by law. By signing the application form you agree to the processing of personal sensitive data (as described above) in accordance with the Data Protection Act, 1998. I agree to the data protection statement above and I certify that all statements given on this form by me are true and correct to the best of my knowledge.
REFERRER’S DETAILS please complete
Name / Source of referral(please P) / HSCP * / Other *
Work Address
Email Address / Date
Work Phone / Mobile
Please return form by email to or send to:
Roar – Connections for Life, West End Community Centre, 5A Underwood Lane, Paisley PA1 2SL
If you require any further information please contact Roar Office on 0141 889 7481. Thank You
Roar – Connections for Life Company Number SC390855 Charity Number SC042041