Organisation or School Name

Position in School/Organisation

Full Name*

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E-mail*

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Work/Mobile*

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Address & Full Post code*

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Individual Application

School Application

Organisation Application (Non-profit)

Company Application

Some individuals have an Educational Health Care Plan

Some individuals may display behaviours that require additional care and attention

Some individuals have been diagnosed with special needs

Interested in a 1-2 hour workshop (For one day only)

Interested in a 1-2 hour, per week workshop (Over a period of 2-12 weeks) Please state the amount of weeks that you require the workshop in the general message area below.

Interested in a half day (4 hour) workshop

Interested in a full day (8 hour) workshop

Amount of individuals to be trained (approximately 1-10)

Amount of individuals to be trained (approximately 11-15)

Amount of individuals to be trained (approximately 16-20)

Amount of individuals to be trained (approximately 21-30)

Amount of individuals to be trained (approximately 30+)

The workshop can be taught at our school/organisation or a venue to be allocated

We require a place to teach the workshop

Please give a brief timescale of when you require the workshop to be taught. For example: within a month or please state the month and year of interest*

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General Message

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

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