Expression of Interest Capture Form

Registration Form - Your details

First Name

Surname

Gender

Date of Birth

/ /

Address

Town/City

Postcode

Email Address

Validate Email Address

Please check your spam/junk folder as some emails from us may be sent there

Landline telephone number

Mobile telephone number

Please check this box if you DO NOT wish to receive course reminders via email

Where did you hear about the Recovery College?

If 'other', please specify

About You

Other (Status)

Primarily, in what role will you be using the Recovery College? As a:

Your Chosen Course

Please note:The Family Hub courses are for individuals who are within the perinatal period (pre-natal or postpartum) with a child who is up to 2 years old.

Preferred Course 1

Preferred Course 1 Start Date

Preferred Course 2

Preferred Course 2 Start Date

Preferred Course 3

Preferred Course 3 Start Date

Preferred Course 4

Preferred Course 4 Start Date

Preferred Course 5

Preferred Course 5 Start Date

Other course of interest, not listed

Your single preferred location

Other preferred location not yet listed

Additional Support

Please outline in brief any additional support or reasonable adjustments that you need us to be aware of prior to your attendance on our courses either online or face to face. eg coloured overlays, larger text, frequent breaks

Emergency Contact

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Number

Equality and Diversity Monitoring

Age Group

Ethnicity

Student Declaration

I have provided at least one way that I can be contacted

Yes No

Information sharing statement

Please read

When you register to attend courses with the Lincolnshire Recovery College, part of Lincolnshire Partnership NHS Foundation Trust you have been asked to provide personal information to help us to be able to communicate effectively with you, support your learning as required and deliver the best standards of educational experience that we are able to. Everyone working for the NHS has a legal duty to maintain the highest level of confidentiality about your information.

The information you provide will be kept together and form a student record. Student records are stored on Mind Recovery Net (Mindrecoverynet.org.uk is a customer relationship management (CRM) software crafted to help Mental Health Recovery Colleges and training providers manage their applications, students, courses, tutors, course schedule, venues, bookings, attendance and impact and outcome assessment.) via the Trusts network. Every reasonable precaution will be taken to safeguard the personal information you have entrusted to us.

Sometimes other agencies could be involved, and we may need to share information with them in order to safeguard. Anyone who receives confidential information about you from us is also under a legal duty of confidence. We will not disclose your information outside these agencies without your knowledge unless the health and safety of yourself or others is at risk or if we are required by law under the Data Protection Act 2018.

You have a right to see and comment on any of the information we hold about you. If you do have any concerns or queries about this, then please discuss this with the College. Further information about our legal basis for processing your information is detailed on our Trust website privacy policy and there is an additional leaflet 'How we use and share your information' to help you. If you do not wish to have your records accessed for research purposes, please visit https://digital.nhs.uk/services/national-data-opt-out-programme to set your choices.

I have read and understood the confidentiality and information sharing information