APPLICATION FOR TRAINING FOR COMPANIONS:

PARENT PROGRAMME

Address

Date, 9.15am-3.45pm

(Limited to Twelve Participants)

The cost of the 1 day course is £100 This includes Course Materials (Seasons for Growth Training costs may vary according to venue but are not for profit. The cost will also include the next Re-connector)

In preparation for the Seasons for Growth Companion Training please complete all of the following information and return to the Name.

I AM A TRAINED COMPANION: Adult Programme ( ) Child Programme ( ) Please tick

DATE TRAINED: ______

Please note below if you have had a change of surname since training.

Please print clearly:

Title: ______First name:______

Surname:______

Occupation:______

Name of Organisation:______

Organisation Address: ______

______Post Code: ______

Telephone:______Fax No: ______

e-mail:______Council: ______

  1. I would like to deliver the programme(please tick):

( )in a primary school

( )in a secondary school

( )in other organisation (please specify) ______

Companions for the Parent Programme will have:

  1. A sound background of delivering a variety of programmes to groups of adults
  2. A clear history with the endorsing organisation, demonstrating their ability to
  3. respect confidentiality
  4. understand child protection and other safety issues for those affected by domestic violence, sexual assault etc

3. Attended to their own grief issues

4. Regular relevant supervision or opportunity for appropriate debriefing

2. Experience of group work with adults: ______

______

______

3. What do you think might present some challenges for you in this area? ______

______

4. Please supply the name and address and contact details of a person who could speak about the contribution you

will make in the Seasons for Growth Parent Programme.

Name: ______

Address:______

Telephone No:______

e-mail:______

Payment details: please tick appropriate box:

Cheque – I enclose a cheque (made payable to Namefor £100)

Invoice – Please send invoice request to the address indicated (please provide below if different from correspondence address

______

______

______Post Code ______

I declare that the information provided on this form is true and correct.

Signed: ______Date: ______

Please return form to:Address

Tel:

Closing date for applications: Date 2017

Confirmation will be e mailed out to all delegates who enclose their fee/invoice order. If you have not received confirmation at least one week before the event please contact Name.

CANCELLATIONS: A £10 administration fee will be charged for cancellations made before the closing date. We are unable to provide any refunds if less than 14 days notice is given.

Data Protection Act: by signing this application, I agree to Seasons for Growth keeping data about me for the administration of the programme, networking, training courses and conferences.