Rainbow badge pledge form :: YourSpace Mersey Care

Complete this form to receive a rainbow badge. This form must be completed by the person requesting the badge so they fully understand what it means. Please do not complete this form on behalf of other people.

Name Required

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We’d like to collect information about what motivates people to wear a badge. We may use this quote anonymously to promote rainbow badges to others. Please tell us in a few words: I would like to wear a badge because... Required

We will keep this comment anonymous unless you are happy to be named Required

None

I would like to remain anonymous

I’m happy for you to use my name and job title alongside my quote

I’m happy for you to use my name and job title alongside my quote and would be happy to be contacted to be involved in further publicity of rainbow badges in the future

I confirm that... Required

I understand wearing a badge gives a positive message of inclusion and means I have a responsibility to be someone who is a friendly ear for LGBT+ people and their families

I have read the information on Connect and explored the support materials for LGBT+ people in the FAQ's

I agree to the privacy policy

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