Enquiries Capture Form

Bedfordshire and Luton Recovery College Registration Form

Your personal details

Title

First Name

Last Name

Date of Birth

/ /

Do you live in Supported Living Accommodation?

Yes No

Please specify the name of the accommodation

Address

Town/City

Postcode

Email Address

Validate Email Address

Borough/County

Home Phone

Mobile Phone

Permission to leave an answer message on home number

Yes No

Permission to leave an answer message on mobile number

Yes No

We will contact you using your preferred method of contact however if we need to contact you by another method, for example in an emergency, we will use the other contact details you have provided.

How would you like to be sent the links for online courses you choose and to receive reminders?

Email
Text/SMS

In order for you to join courses we need to be able to send you the links by email or text/SMS.

How did you hear about us?

If Referal from other Organisation or Other , please state here

Emergency Contact

Emergency Contact Title

Emergency Contact Name

Emergency Contact Number

Emergency Contact Relationship

Courses

Preferred Course 1

Preferred Course 1 Start Date

Preferred Course 2

Preferred Course 2 Start Date

Preferred Course 3

Preferred Course 3 Start Date

Preferred Course 4

Preferred Course 4 Start Date

Preferred Course 5

Preferred Course 5 Start Date

Preferred Course 6

Preferred Course 6 Start Date

What type of courses do you prefer?

Classroom
Online

What time of day would you prefer courses to be?

Your preferred location for attending courses?

Would you like to be emailed when a new prospectus is out?

Yes No

Would you like to be added to our email list to receive regular updates and news about courses?

Yes No

Supporting You

Primarily, in what role will you be using the Recovery College? As a:

What is your connection with Bedfordshire and Luton Recovery College?

Work in Bedfordshire
Live in Bedfordshire
Student in Bedfordshire
ELFT Volunteer or Employee

Please help us identify your support needs with a brief description of the challenges you have faced or may be addressing through current contact with mental health services:

Support Worker Name

Support Worker Email Address

Support Worker Phone

Have you or your partner been a member of the UK armed forces ?

Yes No

Other mental health services. Please provide details

If 'other', please provide details

Your special requirements: Please tell us if you have any special requirements (e.g. interpreter) or access needs (e.g. mobility) that we may pass onto trainers before you attend

Would you like an Individual Learning Plan?

Yes No

Equality and Diversity Monitoring

This information is anonymous and will only be used to monitor who we are engaging with. This will help understand whether we are reflective of the diversity of our population

Gender

Please provide details if so

Do you identify as trans?

Yes No Prefer not to say

Age Group

What is your marital status?

Which of the following options best describes how you think of yourself?

Ethnicity

Other ethnicity

Confidentiality and our promise to you

Thank you for completing this registration form.

Attendees of all our courses are expected to:

maintain the privacy and confidentiality of other attendees.
not to use mobile phones, computers or recording devises during sessions (unless agreed prior to the day).
inform us as soon as possible if unable to attend.

In return the Recovery College will:

ensure the data you have provided us above is kept within GDPR regulations. Your personal data will not be shared outside of the Recovery College without your consent; with the exception of if we have concerns about your wellbeing. In all cases our primary aim will be to obtain your permission first.
offer courses FREE (or at very low cost)
involve our services users in the development of our college wherever possible.

By submitting this enrolment form, you are confirming that you have read and understand how your information will be stored / shared by the Recovery College