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Referral and Registration Proforma 

Therapeutic Gardening Sessions at Cody Dock


By completing this form, you are confirming that you are happy for Gasworks Dock Partnership to hold and use your details in line with our Data Protection Policy.

Introduction

The following represents the criteria for acceptance onto a 6-week course of therapeutic gardening sessions at Cody Dock.

  • No previous gardening experience or knowledge is needed just some interest and a willingness to engage with the activities.
  • We welcome referrals/registration from anyone who wants to improve their mental health, physical health, and general well-being.
  • We particularly welcome referrals/registration from people experiencing depression, anxiety, loneliness, isolation and/or climate anxiety. This list is, however, not exclusive.
  • We also particularly welcome referrals/registration from people with legally protected characteristics i.e., on the basis of their race, gender, gender identity, disability, sexual orientation, age, religion/belief.
  • People registering/being referred will be invited to a site visit/taster session following which, by mutual agreement, will be accepted onto a 6-week course. Participants should commit to coming and taking part once a week for a 2.5-hour session on a Monday morning or afternoon. 

In addition, we aim to work with people who are:


·       Over 16
·       Willing to engage with social prescribing by way of therapeutic gardening activities
·       Able to arrive at/leave Cody Dock and remain on site for the duration of the session unassisted, or who chose to be accompanied by a carer, friend, family member or support worker

We also take referrals/registration and/or expressions of interest from Voluntary and Community Sector Organisations (VCSOs) or community groups wanting to send a group of up to 8 individuals. (If you tick this box, you will be asked a couple of questions and will be contacted by the GDP Team  for further discussion). Pre-arranged group sessions will take place on Tuesdays, either morning or afternoon.


Referral Type

Personal Details




Personal Details





Details of Individual you want to refer 




Contact Details





Reason for referral
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General Questions







General Questions







General Questions