RHS LEVEL 2 PRACTICAL HORTICULTURE ENROLMENT FORM

Course Details
Course title: / RHS Level 2 Practical Horticulture / Course Location: / Beanstalk Gardens,
Falconer Barns Smallage Lane,
Fence,
Sheffield
S13 9ZH
Course number: / 501/0207/2
Centre number:
Course tutor: / Abigail Pickersgill
Start date : / End date: / Times: / 10:00-12:30 1:00-3:30
Personal Details
Male Female / Mr Mrs Miss Ms Other
First name: / Last name:
Address: / Date of Birth:
Home telephone:
Mobile Phone:
Postcode: / Email:
Payment Details
Terms and conditions -Totalcourse fees are payable once enrolled and the course starts. There is a 14 day cool off period once enrolled and before start date where money can be refunded. After the course start date if for whatever reason you leave the course the total course costs of £950 must be paid. Any none payment of course fees may result in debt collection procedures.
Course Fee: / £950 / Payment method: / Full payment on enrolment / Payment by instalments
Card: / Cheque: / Bank:
Card payment: please phone our finance department on 01143 840285
Bank transfer or standing order: Our Bank details :please use these details to pay for your course in full or set up a standing order
Bank name: / Santander / Account name: / Autism Plus Limited
Account number: / 10097726 / Sort code: / 09 02 22
Cheques: please make payable toAutism Plus Limited. These should be sent so that we receive it 10 days prior to course start date.
Signed: / Dated:
You must sign and date to state that you have read the terms and conditions and agree to them.
Qualifications-Please tick the highest level qualification you have achieved: (examples provided)
No qualifications
Other qualifications below Level 1
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6 / QCF Award/Certificate Entry Level
5 or more GCSE grades at D-G, NVQ level 1, QCF Award/Certificate Level 1
5 or more GCSE grades A – C, QCF Diploma/Certificate Level 2
2 or more A levels, 4 or more AS Levels, NVQ Level 3, QCF Diploma Level 3
QCF Diploma/Certificate Level 4, HNC
QCF Diploma/Certificate Level 5, HND
QCF Diploma/Certificate Level 6, Degree
Are you enrolled in any other education/ courses? / Yes No
If yes, please give details?
ULN (if known)
Have you ever enrolled or completed another horticulture course? / Yes No
What are you most interested about this course?
Disability (in order for us to meet your needs)
Do you have a disability and/or health problem? / Yes (Please tick all that apply) No
Visual impairment
Hearing impairment
Disability affecting mobility
Other physical disability
Other medical condition e.g. epilepsy, asthma, diabetes
Emotional/behavioural difficulties / Mental health difficulty
Temporary disability after illness e.g. post viral, accident
Profound complex disabilities
Aspersers Syndrome
Multiple disabilities
Other
Learning Difficulty (in order for us to meet your needs)
Do you have a learning difficulty? / Yes (Please tick all that apply) No
Severe learning difficulty
Dyslexia
Dyscalculia
Other specific learning difficulty / Moderate learning difficulty
Autism spectrum disorder
Multiple learning difficulties
Other
Learner Declaration:
I formally accept the learning programme specified on this agreement.
I confirm that I have been provided with information on Health & Safety, Equality & Diversity, Safeguarding and the Complaints procedure.
I certify that the information I have provided is correct.
Date:Date:
Learner Signature: Tutor Signature:
Privacy Notice - How We Use Your Personal Information
The personal information you provide is passed to the RHS for course monitoring. The RHS and Beanstalk Gardens may want to contact you with information about future courses or general information.
Do you wish to be contacted by RHS after this course? Yes No
Do you wish to be contacted by Beanstalk Gardens or Autism Plus? Yes No
Tick this box if you wish to be contactedin respect of surveys and research by: mail phone e-mail
Tick this boxif you wish to be contacted about courses or learning opportunities by: mail phone e-mail
Equal Opportunities – You do not have to fill in this section if you do not want to
Ethnic Origin - Please tick one box that best describes your cultural background:
White
English/Welsh/
Scottish/Northern
Irish/British
Irish
Gypsy or Irish Traveller
Any other White
Background
/ Mixed/Multiple
Ethnic Group
White and Black
Caribbean
White and Black
African
White and Asian
Any other Mixed/
Multiple Ethnic Background / Asian/Asian
British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian Background / Black/African/
Caribbean/
Black British
African
Caribbean
Any otherBlack/African/Caribbean Background / Other Ethnic Group
Arab
Any other Ethnic Group
What is your religion or belief (if any)?
Buddhism
Hinduism
Islam
Sikhism
Other please specify / Christianity
Humanism
Judaism
No religion or belief
Prefer not to say
Is your gender identity the same as the sex you were assigned at birth?
Yes No Prefer not to say
What is your sexual orientation/sexuality?
Heterosexual/Straight Bisexual Lesbian/Gay Prefer not to say