Please type or hand-write in upper case, ensuring that you complete all relevant sections.

SECTION 1: Personal details

Registration Number:

Surname:

Forename(s):

Address:

Email:

Tel:

SECTION 2: Employment status(complete either A or B)

  1. I am currently practising as an HPS* and wish to re-register.

Title of Post (eg. HPS):

Place of Work (eg. name of NHS Trust):

Full time / Part time (no. of hours):

(Please proceed to Section 3)

  1. I am not currently practising as an HPS and wish to lapse my registration.

I have retired / do not work

I am not currently practising due to...

Signed: Date:

Print Name:

Registration no.

SECTION 3: Confirmation of re-registration criteria.

I confirm that during the past two years I have been practising my profession – drawing on my professional knowledge and/or skills in Healthcare Play Specialism in the course of my work; OR

I have undertaken a period of updating as I have recently returned / wish to return to practice;AND

I have maintained a record of my continuing professional development (CPD) which reflects the standards set out by HPSET; AND

I can confirm that my current health and character are sufficient to enable me to practice safely and effectively.

I DECLARE that all the above information is true and correct.

Signed: Date:

Print Name: Registration no:

CHECKLIST:

I have updated my personal details[ ]

I have read and signed the declaration in Section 3[ ]

I have enclosed a signed copy of Code of Professional Conduct[ ]

I have enclosed my CPD Profile [ ]

I have enclosed a cheque (or proof of payment)to the value of £79.00, made payable to HPSET, with my registration number on reverse [ ]

Please return application by post to: RegistrationCoordinator, Box 205, 44-46 Morningside Road, Edinburgh EH10 4BF. Email: