Breeze Culture Network

Equality & Safeguarding Requirements for Practitioners

Freelance practitioners using the Breeze Culture Networkare required to uphold the principles of equality and to have key safeguarding measures in place to protect children and young people. To make full use of the Breeze Culture Network you must have:

  • an enhanced CRB/DBS Disclosure carried out within the last 2 years or a current DBS registration
  • Public Liability Insurance to protect against third party claims
  • Contact details of two referees relating to education and community work carried out within the past two years that may be taken up by prospective employers

If you have any queries about Disclosure and Barring Service please visit

Please return this completed form to via email to

If you have any queries about this form or Breeze Culture Network in general please email

1: Contact Details
1.1 Name: / 1.5 Address for correspondence:
1.2 Trading As (if applicable): / 1.6 Postcode:
1.3 Email address: / 1.7 Main telephone number:
1.4 Website address: / 1.8 Mobiletelephone number:
2: Enhanced CRB Disclosure/DBS Registration
2.1 an enhanced CRB Disclosure carried out within the last 2 years / Y/N
Or a current DBS registration? / Y/N
NOTE: If you answer ‘No’ to either of the questions above you will not be activated on the Breeze Culture Network
If Yes, please provide the following information...
Date of CRB check/DBS registration:
CRB Number /DBS Registration:
Name of Agency that processed your CRB Check:
3: Public Liability Insurance
3.1 Do You have a current Certificate of Public Liability Insurance
Certificate Number: Provider/Insurer:
4: Referees
4.1 Referee 1
Name
Organisation
Position
Address
Postcode
Telephone
Email
4.2 Referee 2
Name
Organisation
Position
Address
Postcode
Telephone
Email

Data Protection Act (1998)

We are required to ask you to grant your permission for Breeze Culture Network to keep your details on record in accordance with GDPR. Please tick one of the boxes below to indicate your informed consent:

I, the signatory, do give permission for my contact details to be kept on record by Breeze Culture Network, in accordance with GDPR. I understand that I may be contacted from time to time by Breeze Culture Network.
I, the signatory, do not give permission for my details to be kept on record by Breeze Culture Network, in accordance with GDPR.
DECLARATION
I DECLARE THAT I AM AUTHORISED TO PROVIDE THIS INFORMATION AND THAT IT IS ACCURATE TO THE BEST OF MY KNOWLEDGE
NAME (CAPITALS):
SIGNED:
DATE:

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Breeze Culture Network Safeguarding & Equality Form – Practitioners – June 2018