Please Complete This Form to Request a Place on the Sheffield Safeguarding Adultstraining

Please complete this form to request a place on the Sheffield Safeguarding Adultstraining programme.

Course name:
Course date:
Venue:

First name:

Family name:

Job title:

Work telephone:

E mail address:

Name of your Organisation
Worksite Address and Post Code / Address:
Post Code:
If your organisation is Externalto the Council, please supply the following: / Your Manager’s Name:
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Address if different from above:
If your organisation is Internal to the Council, please supply the following: / Your Manager’s Name:
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Business Unit Code:
What type of support does your organisation provide
If you come from SCC Communities Portfolio, please specify your service area and employee number / Service Area:
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Employee Number:
Do you have any special needs -[access, loop system, large print materials etc.]
Please let us know:
Have you received any previousSafeguarding Adults training?If yes – please give details

Our courses/workshops are free for staff in partner agencies; if your organisation is not a partner of the Sheffield Adult Safeguarding Partnership, we will contact you about the cost of your place.

Cancellation:If you cancel your place, after it has been confirmed, your organisation will be charged £50 per day, for each day cancelled. The charge for the ½ day courses will be £25. You can contact us to request a substitute from your organisation up to the day before the training, at no extra cost.

Non-Attendance:If you do not attend the training, and did not contact us to cancel your place, your organisation will be charged £80 per day, for each day of non-attendance. The charge for the ½ day courses will be £40.

EQUAL OPPORTUNITIES MONITORING

Please complete this section to help us ensure that our training reaches all groups.

Gender

/ Male / Female
Do you consider yourself to be disabled / Yes / No
Age / 16-24 / 25-34 / 35-49 / 50+
Ethnicity / White British / Irish / Asian or Asian British / Black or Black British
Chinese or Chinese British / Mixed/Dual Heritage / Any Other Ethnic Group – please state

Please return this form to: Safeguarding Adults Office, Floor 10, Little West Wing, Moorfoot Building, Moorfoot, Sheffield. S1 4PL

Or email to