Recovery College registration form Recovery College Registration Form MAILING LISTS Would you like to be added to our mailing list to receive our prospectus/timetables and further Recovery College information for this academic year and next year? Please tick Yes No Personal & Contact InformationName* First Last Date of Birth* DD slash MM slash YYYY GenderMaleFemaleNon-specifiedPrefer not to sayAddress* Street Address Address Line 2 Town/City Postcode Contact Number*Additional contact numberEmail Enter Email Confirm Email Preferred method to receive codes for online sessions* Email Text Both CONTACT DETAILS IN CASE OF EMERGENCYName First Last Contact numberTHE FOLLOWING ARE USED FOR MONITORING PURPOSES ONLYAre you a returning student? Are you a returning student? Are you registering to support someone? Please tell us whether you are (tick all that apply): Person with Lived Experience NHSCT Staff Other HSCNI staff Health Professional Public Sector (Civil Servant, Fire Service etc.) Private Sector Staff Community/Voluntary Staff Carer Retired Student Unemployed How did you hear about the Recovery College? (tick all that apply) Key Worker GP Facebook/Social Media Search Engine Health Fair Word of mouth Trust intranet/Broadcast Email Other Course RegistrationCourse 1* Date(s) Venue Course 2 Date(s) Venue Course 3 Date(s) Venue Course 4 Date(s) Venue Course 5 Date(s) Venue Please list any additional course(s) below if you wish to register for more than 5Please outline in brief, any difficulty which may make it hard for you to attend or fully benefit from any courses you have registered for. This could connect to mental health learning difficulties or a disability issue (including reading and writing).IMPORTANT INFORMATION Please be advised all venues, dates and times are subject to change. Please ensure you have provided us with a current contact number so we can notify you of any changes that may occur CANCELLING A COURSE If you have registered and can no longer attend a course, please contact us as soon as possible to cancel. You can contact us via telephone or emailHiddenFor Official Use OnlyHidden Current Student Added to Student Databse Added to Courses Database Confirmation Letter Complete Student Number ________________ EmailThis field is for validation purposes and should be left unchanged.
