S.M.A.S.H. Registration Form

Complete the form below to participate in the Separation Mediation Access & Support Hub.

All information provided will be treated confidentially and used solely for the purpose of assessing your application.

Your Full Name

Your Contact number

Your Email

Your Partner's Name

Your Partners number

Your Partners Email

What is the current status of your Seperation?

Preferred Date

Friday 27th November 2026

Saturday 28th November 2026

Sunday 29th November 2026

Are there children involved?

Yes

N/A

What is the single biggest roadblock you both want to clear or discuss during this 1-hour block?

I consent to Strategic Support Ireland contacting me and the other party named in this application in connection with the S.M.A.S.H. Initiative, including eligibility assessment, appointment scheduling and mediation-related communications. I understand that participation is voluntary

I understand and agree that the personal data provided in this application may be processed by Strategic Support Ireland for the administration, assessment and delivery of the S.M.A.S.H. Initiative and associated mediation services, in accordance with the Privacy Policy and applicable data protection legislation.

S.M.A.S.H. Registration Form

Advanced settings