NSPCC Branded Word Template
Controlled upon completion
This Booking Form is required for completion in order to process the delivery of the NSPCC Speak out. Stay safe. Assemblies and Workshops. Please return to Linda Ricketts- along with a signed copy of the NSPCC Speak out. Stay safe. Programme Agreement to: .
Date:Name of School & address & telephone number
Name, email address and role of person completing this form:
Name and email address of Head Teacher:
Name and email address of Designated Child Protection lead if different:
Number of pupils in year 5 and 6
Number of pupils in year KS1
Number of pupils in year KS2
Please indicate 3 preferred
dates and times for:
20 minute KS1 Assembly
30 minute KS2 Assembly
With usual class teachers present. Access required to laptop, screen and speakers.
10am onwards where possible to avoid traffic delays / 1 Date:
KS1 Time:
KS2 Time
2 Date:
KS1 Time:
KS2 Time:
3 Date:
KS1 Time:
KS2 Time:
Please indicate 3 preferred days and or
dates for the Workshop Years 5 & 6 deliveries
All Y5 and 6 pupils together with usual class teachers present. Access required to laptop, screen and speakers
NB: Workshop sessions can take place over more than 1 day if required
· Some workshops may be able to be run concurrently / 1 Date:
Start Time:
2 Date:
Start Time:
3 Date:
Start Time:
Class Name / Number of Children / Teachers Name / Suggested times from – to ?
Are there any L.A.C or children sensitive to our message
Are there any children with additional needs or children with English as an additional language?
Is there audio-visual equipment in assembly hall and classrooms? Windows PC is ideal for our materials please circle which IT equipment you have please / Mac
Windows PC
*Where possible provide windows PC equipment
Who can the resources be sent FAO of at the school. State any dates near to the delivery to avoid such as holidays?
Are there any parking restrictions at the school?
Any additional information please indicate here:
It’s the schools responsibility to inform carers and parents that we will be undertaking the delivery in their school
Ticking here indicates that you agree to this.
Would you like to undertake a non uniform day or other, to support the NSPCC.
(Service continues to be free of charge to schools however any donation helps us continue to deliver safeguarding messages to children.) / YES
NO
Finally- please sign the School Agreement (Below) and send via email along with this booking form. Please note a signed school agreement has to be received for the delivery of the service to take place. / Please Sign page 5 of the School Agreement. Please provide an ink hand written signature. Ideally scan & email. Thank you
Once again, Thank you for your continued interest in the NSPCC schools service.
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NSPCC Speak Out, Stay Safe Programme Agreement