Register interest in our FREE 10-week programme, open to new mothers living in the London Borough of Croydon experiencing low mood, feelings of stress, anxiety or social isolation with babies aged 0-9 months.

Woodlands Family Hub, Farnborough Ave, South Croydon, CR2 8HD

  • Tuesday 12th May to Tuesday 14th July 2026, 10.30am to 11.30am

Samuel Coleridge Taylor Family Hub, 194 Selhurst Rd, London SE25 6XX

  • Wednesday 13th May to Wednesday 15th July 2026, 10am to 11am and 11.40am to 12.40pm

Completing this form is the first step to attending a Breathe Melodies for Mums programme. Once submitted, you will hear from one of our team who will be able to provide guidance on next steps as well as answer any questions you may have.

If you require help completing this form or would like to receive it in a different format please contact us on [email protected].

We look forward to hearing from you!

Personal Details


All fields are mandatory.

Mother's Full Name: Mother's Age: Mother's Date of Birth: What gender do you identify with? Which language do you speak mostly at home? What is your ethnicity: Baby's Date of Birth (Please note to be eligible for this programme your baby must be aged 9 months or younger at the start of the programme): Baby's name: Email: Confirm email: Telephone: Postcode: Borough of Residence: Name of GP Surgery: Person to contact in case of emergency for you: Emergency Contact Mobile number: Recruitment Method: (select from dropdown) Other, please specify: Please select your preferred session: Do you have any access or support needs to ensure you can take part in this activity? (E.g. wheelchair access, captioning for online activity, large print information, sign language interpretation). We can provide financial support for travel if needed (e.g. taxis). If you answered yes to the question above, please give detail below:

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By submitting this form you are consenting to our privacy policy.
The data collected will be anonymised and shared with Croydon Council who are funding this programme for the purposes of reporting.