Get Workplace Ready Booking Form

Section 1: Applicant Details

Name (Required)

First Last

Date of Birth (Required)

Gender (Required)

Male

Female

Prefer not to say

Other

Pronouns (Required)

Home Address (Required)

Address: Town / City: County / Region: Postcode: Country:

Email (Required)

Enter Email Confirm Email

Phone (Required)

Section 2: Emergency Contact (EC) Details

EC Full Name (Required)

First Last

EC Relationship to Applicant (Required)

EC Pronouns (Required)

EC Home Address (Required)

Same as applicant

Different to applicant

Home Address (Required)

Address: Town / City: County / Region: Postcode: Country:

EC Email (Required)

Phone (Required)

Section 3: Medical Details

Medical information (including allergies), other disabilities and/or additional information we need to be aware of for the duration of this activity. Please also detail any medication taken we need to be aware of (please note that all participants must be able to administer their own medication independently and residential staff and volunteers can not support with this). (Required)

Dietary information including any allergies. Please ensure this is as accurate as possible as this information is used to inform catering teams. (Required)

Please provide any information that you think may be relevant.

Section 4: Eye Condition

Are you registered blind or partially sighted? (Required)

SI (partially sighted)

SSI (blind)

Not registered

What eye condition(s) do you have? (Required)

How does this affect you? (Required)

Any additional details?

Section 5: Independence Skills

Do you use a mobility aid? e.g. long cane or guide dog. (Required)

Use of toilet (Required)

Independently

With some assistance