Green Skills Participant Booking Form

Please complete all relevant sections in BLOCK CAPITAL LETTERS, sign the form and send to ECO-UNESCO. Contact details below.

PART 1: PARTICIPANT DETAILS

Individual’s Details


First Name(*)
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Last Name(*)
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Home Address(*)
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Mobile Phone(*)
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Home Phone
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Email
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Date of Birth
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PPS Number
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Emergency Contact

Name
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Relationship to you
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Contact Number
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E-mail
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Support Workers

Support worker/youth worker/social worker/counsellor/keyworker etc.

Name
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Position
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Organisation/Service
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Contact Number
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E-mail
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Name
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Position
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Organisation/Service
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Contact Number
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E-mail
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Gender
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PART 2: PROGRAMME START DATE

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PART 3: EDUCATIONAL DETAILS (please the tick boxes that apply below)

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Name of modules
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Name of modules
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Name of course
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Name of course
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Candidates need to be able to demonstrate functional numeracy and literacy skills (reading, writing and maths).

PART 4: OTHER INFORMATION

1. Why do you want to do the Green Skills Course?
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2. Have you any special requirements/disability/allergy /addiction/issue that we should know about?
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If yes, please outline the supports you require. (Please enter your requirements below)
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3. Are you on any medication?
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If yes, please outline below. (Please enter your requirements below)
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4. Are you committed to the course and to attending on a full-time basis month period?
(Attendance is expected for each day of the course from Monday – Thursday 10am-3pm).
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5. Please list some companies that you are interested in carrying out your work placement in (please note the companies do not have to be green; they can be an any area of your interest):
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6. Have you participated in an ECO-UNESCO event in the past?
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If yes, please specify which course/event. (Please enter course/event below)
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7. How did you hear about our training programmes? (Please tick the options that apply)
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(Please specify in the box below)
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PART 5: TERMS & CONDITIONS

Your place will be reserved only when we decide that you are a suitable match for the course after the information session and a signed and completed booking form has been received by post or email. The allocation of places will be by date of application and will only be offered to suitable candidates who meet the Learner Profile and eligibility criteria.

Data Protection and Privacy: We will not share your details with any third party with the exception of FETAC if appropriate. Your details will be maintained within our participant files and we may contact you in the future about other ECO-UNESCO services. All participants are signed up to our monthly e-bulletin newsletter. You may unsubscribe at any time.

Policy on the use of photographs and video: ECO-UNESCO may use images and/or video from our activities for publications, promotional purposes and FETAC award requirements. The signature of a parent or guardian is required for young people under 18 years of age. You can sign on behalf of your group / school / organisation if you have previously collected parental permission. By signing on behalf of your group / school / organisation you are confirming you have parental permission.

Medical Assistance: By signing this form, you are authorising ECO-UNESCO to undertake appropriate first aid assistance in case of injury, accident or medical emergency.


PART 6: PARTICIPANT AGREEMENT

Name:(*)
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Date:(*)
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Check the box to indicate that you have read and agree to the Terms and Conditions
Please note: by completing this form you are not guaranteed a place on the course. Green Skills places are allocated on a first come first serve basis and to candidates who fulfil the course profile. I declare that the statements made by me in this document are true and that the accuracy thereof shall be a condition of any place offered to me by ECO-UNESCO and I accept all the Terms and Conditions (the above signed).
(*)
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