Adobe FormsCentral

Enrolment Form
First Name*
Last Name*
Address*
Post Code*
Date of Birth*
Borough (Southwark, Lambeth, Lewisham, Croydon, Other)*
Email
Phone*
Mobile
Your bookings will be confirmed by email or post. Please tick which you would prefer:*

EmailPost
If you have given us an email address, we would like, occasionally, to share with you our latest timetable, news on new courses, updates as to when and where our courses are running, as well as opportunities and developments that we feel may be of interest or benefit to you. In order to comply with the General Data Protection Regulation (GDPR) we need your consent to do this. Please tick one of the following:*

Yes, I am happy to receive emails from SLaM Recovery CollegeNo, I do not want to receive emails from SLaM Recovery College (apart from course confirmations if that optio chosen above)
Please choose which of these best describes your connection to SLaM:*

SLaM Service UserSLaM Supporter (carer, family member or friend)SLaM Peer SupporterSLaM VolunteerSLaM Involvement RegisterSLaM Staff Member
Emergency contact details:
Name
Phone Number
If you are a service user, volunteer or peer supporter, or on the Involvement Register, please tell us the details of your main contact at SLaM:
Contact Name
Team, Department, CMHT etc.
If you are a supporter (carer, family or friend) please tell us the name of the person you care for and the details of their main contact at SLaM:
Name of the person you care for:
SLaM Contact Name:
Team, Dept., CMHT etc.:
If you are a SLaM employee please tell us the details of your team/department and your Clinical Academic Group:
Team
Borough Directorate / CAG
Enter the course or workshop title, start date (DD/MM/YY) and venue:
Course 1*
Date*
Venue*
Course 2
Date
Venue
Course 3
Date
Venue
Course 4
Date
Venue
Course 5
Date
Venue
Course 6
Date
Venue
Please let us know of any difficulty which may make it hard for you to attend, or fully benefit from, any of the courses:
equality and diversity monitoring
We want everyone to be able to access and benefit from the Recovery College fairly and equally. Answering the next set of questions will help us understand if we are doing this. The information you give will be kept confidential and will only ever be used in an anonymised form to help us audit the value, inclusiveness and accessibility of our courses. If you would prefer not to answer any question, please leave that section blank.
What is your gender ?

MaleFemale
Is this the same gender that you were given at birth?

YesNo
What is your sexual orientation?

BisexualHeterosexual/straightLesbian/GayNot sure
What is your marital status?

SingleMarried or in a civil partnershipDivorced/separatedWidow/widower
Age range

16-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465+
Ethnic originHow would you describe your background?
Asian or Asian British

BangladeshiIndianPakistaniOther
Black or Black British

AfricanCaribbeanOther
Chinese and other ethnic groups

ChineseOther
Mixed heritage

White and AsianWhite and Black AfricanWhite and Black CaribbeanOther
White

BritishEnglishIrishScottishWelshOther
Employment status Which of these statements best describes your current situation?

Full-timePart-timeSelf-employedNot employedUnemployedUnable to workRetiredStudentHomemaker
How would you describe your religious or spiritual beliefs?

BuddistChristianHinduJewishMuslimSikhNo religionOther
Do you consider yourself to have a disability?

YesNo
If yes, please tick all that apply:

Physical impairmentVision impairmentHearing impairmentMental healthLearning disabilityLong-standing illnessOther
Do you have caring responsibilities?

YesNo
If yes, please tick all that apply:

Primary carer of child/childrenPrimary carer of disabled child/childrenPrimary carer of disabled adult/adultsPrimary carer of older person/peopleSecondary carer
Should be Empty:

Enrolment Form