Enquiries Capture Form

Recovery College Registration Form

If you are new to Recovery College, you need to complete this registration form. The registration form provides us with your personal details so we know how to contact you, if you have any support needs we need to be aware of, and your emergency contact details.

If you have been to Recovery College before, and already filled this form in then you do not need to fill it in again. Instead, please email recoveryonline@nsft.nhs.uk with the courses you are interested in and our administration team will process your booking and confirm that the existing details we have for you are correct.

Your personal details

Title

First Name

Known as

Surname

Date of Birth

/ /

Address

Town/City

Postcode

Email Address

Validate Email Address

Contact Telephone Number

About you

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

Are you attending with the person you support or on your own for your benefit?

With the person you support
On your own for your benefit

Cared for: Full Name

Cared for: Date of Birth

/ /

Which of the following best describes you? (Tick the appropriate boxes)

Staff member from third sector - State organisation

NSFT staff - Please state team and line manager

Other - Please state

Have you attended the Recovery College before?

Yes No

How did you find out about NSFT Recovery College?

If Other , please state here

Courses Please note that we may not be offering all the courses on the drop-down at present, but it helps us plan for courses in the future.

Preferred Course 1

Preferred Course 2

Preferred Course 3

What location do you come from?

Supporting you and your requirements

Please complete the below section if you have any special requirements we should be aware of.

Please note that whilst our courses are being held online we are unable to provide any physical items such as communication cards and stress balls. We will provide these when we return to classrooms so please continue to tick these boxes so we know you would like them in the future.

I am interested in discussing one or more of the following adjustments before I attend my Recovery College course:

Use of time out cards
Use of stress balls, fiddle things, distraction items
Use of colouring books
Lighting adjustments
Use of communication cards
Adjustments to written material
Additional support with reading and / or writing
Use of colour overlays
Interpreter

Do you have any specific medical needs we should be aware of?

Physical mobility adjustment or aids

Anything else?

Emergency Contact Details We need to have an emergency contact number in order to process your registration form.

Emergency Contact Full Name

Emergency Contact Number

Emergency Contact Relationship

Other Information

Preferred method of contact

Email
Text/SMS

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

Other (Gender)

What are your preferred pronouns?

Other (preferred pronouns)

Have you re-assigned your gender from the one given at birth?

Yes No Prefer not to say

Ethnic origin

How would you identify your sexual orientation?

The Equality Act 2010 defines disability as a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities. The Act defines 'substantial' as being more than minor or trivial ? e.g. if it takes much longer than it usually would to complete a daily task like getting dressed. 'Long-term' is defined as lasting for a period of 12 months or more? e.g.a breathing condition that develops as a result of a lung infection

Please specify disability

How would you identify your faith or belief system

Other faith affiliation

Thank you for completing this registration form.

Your registration details will be stored securely in accordance with data protection law and used for the sole purposes of managing and monitoring the Recovery College. Please feel free to email or telephone us with any questions