THIS PROGRAMME IS NOW FULL, BUT YOU CAN REGISTER INTEREST IN THE OCTOBER PROGRAMME.

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

Ellen Brown Family Hub, 145 Grange Rd, London SE1 3EU

  • Dates tbc

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 (only residents of Southwark are eligible): 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 - waiting list only: 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.