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

South Bermondsey Children and Family Centre, Tenda Road, SE16 3PN

Tuesday 29th January to Tuesday 2nd April 2026, 1.30pm to 2.30pm and 3pm to 4pm

Completing this form is the first step to joining Breathe Melodies for Mums. Once it’s submitted, we’ll be in touch with what happens next.

If you need help completing this form have any questions please contact us on [email protected] or 07511 214 069.

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 (Please note to be eligible for this programme your baby must be aged 9 months or younger at the start of the programme): 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 Southwark Council who are funding this programme for the purposes of reporting.