Sign up for our FREE 10-week online programme, open to new mothers living anywhere in the world experiencing low mood, feelings of stress, anxiety or social isolation with babies aged 0-12 months. 

Thursday 30th January to Thursday 3rd April; 10am to 11am and 11.15am to 12.15pm

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 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 m4m@breatheahr.org or 07511 214 069.

We look forward to hearing from you!

Personal Details


All fields are mandatory, please complete the form in full to ensure your registration is processed as quickly as possible.

Mother's Full Name: Confirm Mother's Full Name: Mother's Date of Birth: Baby's Full Name: Baby's Date of Birth (Please note to be eligible for this programme your baby must be aged 12 months or younger at the start of the programme): Baby's Gender: Email: Confirm email: Telephone: Flat / House Number & Street: City: Postcode: UK Region of Residence: (select from dropdown)
Emergency Contact Full Name: Emergency Contact Number: GP Practice: GP Contact 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) If you answered yes to the question above, please give detail below:

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