Birmingham Safeguarding Children Board

Conference Booking Form

You are required to complete ALL of this Booking Form for the BSCB to process it –

PLEASE NOTE: Failure to complete all the Booking Form will result in no place being allocated

CONDITIONS OF BOOKING:

•Delegates must obtain their Managers Permission to attend a Birmingham Safeguarding Children Board Training Conference.

•Delegates must provide a Budget Code or Invoice Address at the time of Booking.

•Delegates will be charged for non-attendance.

•Delegates will not receive a Certificate if they do not stay till the end of the course.

•Delegates must sign the Attendance Register. Failure to do so will result in a non-attendance charge.

•All cancellations must be made in writing via

Course Title:Serious Case Review Training (AM or PM Session) / Course Date: Drop down fieldThursday 29th March 2012Thursday 26th April 2012 / Session:AM PM
Name: / Please indicate your Agency & Department
Birmingham City Council. Department:
NHS/PCT (Please state which trust):
Children’s Social Care
CAFCASS
Connexions
Police (Please state which department):
Probation
Youth Offending
Schools and Further Education institutions:
Sure Start/Children’s Centres:
Youth Services /Child & Family Education Service:
Voluntary / Private and Independent Sector:
Other:
Job Role:
Email Address:
Address:
Postcode:
Telephone No:
Please confirm you have your Managers Approval to attend and that they are aware of the cancellation policy? Drop down fieldYesNo (The BSCB will not be able to process this Form
Manager Name: Managers Email:
Please Note: that your Manager is agreeing to the BSCB cancellation policy as outlined in the box below:
If you should cancel or failto attend and are notreplaced by an ‘appropriate’ substitute your agency will be charged a fee in accordance with the following scale: / Notice of
Cancellation
20 working days notice
10 working days notice
5 working days notice
Failure to Attend / % of confirmed charges
50%
75%
100%
100% /
Full Day
Charge
£50.00
£75.00
£100.00
£100.00 / Half Day
Charge
£25.00
£37.50
£50.00
£50.00
BCC Employees ONLY – Must be completed (either Budget Code or Project Code – All spaces must be completed):
Budget Code
/
Project Code:
- - / / Invoice Address (All external Agencies – Must be completed):
Postcode:
Gender
Male
Female / AgeRange
Under 20
20 – 29
30 – 39
40 – 49
50 – 65
65 and over / White
British
Irish
Other / Mixed(white & black)
Caribbean
African
Asian
Other / Asian or Asian British
Indian
Pakistani
Bangladeshi
Other / Black of Black British
Caribbean
African
Other / Chinese or other
ethnic group
Chinese
Other
Do you have a Disability where support or equipment will be required Yes No -
Please specify any requirementswhich will assist you on the day

How have you heard about this BSCB Training?

If you require any more information on the above please contact: Birmingham Safeguarding Children Board, Room B54, Council House Extension, Margaret Street, Birmingham, B3 3BU. Tel: 0121 464 2612

Email:

IN ORDER TO SECURE A PLACE ON THE COURSE PLEASE COMPLETE ALL OF THE ABOVE

Please Note: You are required to complete all of the above booking form for the BSCB to process. Sending in an application form does not automatically mean a place on the course (unless otherwise stated). Please wait for confirmation of your place which you will need to bring with you on the training day. Each individual is required to complete the form in full (one form per applicant). When applying for more than one course please use separate forms for each course!

Data Protection Act 1998: Please note that in accordance with the data protection act 1998, your details in relation to attendance

at this event will only be used for analysis, evaluation, monitoring and statistical purposes. Your information may be shared with

other agencies in connection with the BSCB activities, plans and policies.