Apply to Daylight

Please use this form to apply to Daylight yourself or to refer someone else to Daylight. If you are referring someone else, give the potential client's details as appropriate.

* denotes a required field

First name *

Last name *

Date of birth *

Address *

Phone Number *

E-mail *

Please give details of days and times (eg mornings, evenings) when you are available (or unavailable)

If you are referring someone else, please fill in your name and contact details here

Please tell us your main issues and current symptoms that require counseling or therapy *

Please enter the number of cars you can see in the picture to show that you are a human.

Please read and agree to our terms and conditions

All Daylight members are unpaid volunteers and we do not make a charge for counselling sessions. We are all motivated by our Christian faith but our service is open to all and your counsellor or therapist will not impose her/his own beliefs and opinions on you, but accept you as you are. Daylight relies entirely on voluntary donations to cover its day-to-day running costs.

Our guarantee to you

  • We will provide a counselor or therapist who is suitably trained to help you.
  • We will treat you in a professional manner with empathy and consideration.
  • We will respect your identity, beliefs and lifestyle choices.
  • We will give you advanced notice if we have to change one of your seesions for any reason.

Your undertaking to us

  • I will keep appointments or let my counsellor or therapist know as soon as possible if I need to cancel.
  • I will not come to appointments under the influence of alcohol or non-prescription drugs.
  • My mobile phone will be switched off or silent during sessions (unless agreed otherwise with your counsellor for a specific reason).
  • I will seriously consider whether I can afford to contribute to Daylight's costs.

I understand and agree to this undertaking.

Data protection and Confidentiality

  • All personal data is kept securely and only used to facilitate my use of Daylight's services.
  • My name, phone number and e-mail address will only be stored on my counsellor's phone with my permission and in order to facilitate change of appointments, etc.
  • My data may be used in written work as part of counsellor training or in counsellor supervision. However, I understand that no data that enables me to be identified will be disclosed in this way.
  • Daylight keeps personal data and session notes for up to 4 years after which they are shredded or deleted. Texts and e-mails will be deleted as soon as no longer needed administratively.
  • My information will not be shared with any third party without my permission unless:
    a. There appears to be high and imminent risk to my own or another's safety,
    b. Disclosure has a high likelihood of being effective in preventing serious harm,
    c. Rare legal obligations require disclosure

I understand and agree to my personal data being used in these ways.

Grievances

  • If you have a grievance about any aspect of Daylight's service, please first speak to your counsellor or therapist. However, if you still feel dissatisfied then contact the directors by letter addressed to: Daylight Directors, 85 Church Street Leigh WN7 1AZ)