Skills Bootcamp Form

Skills Bootcamp

Learning Agreement
1. Learner Information
Title*
Other Title*
Surname / Family Name*
First Name(s) in Full*
Previous Name (if applicable)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
If you've changed address within the last 3 years, please provide previous postcode:
Date of Birth*

DayMonthYear
Date
Age (at the time of filling this out)*
Legal Sex (stated on passport / birth certificate)*

MaleFemale
Gender*

MaleFemaleOther
Undergoing Gender Reassignment*

YesNo
Mobile Number*
Please enter a valid phone number.
Email Address*
example@example.com
National Insurance Number*

2. Further Information
Please indicate your ethnic group*
Do you have any criminal conviction(s) (Excluding minor motoring offences)*

YesNo
Are you currently caring for children or other adults*

YesNo

3. Emergency Contact Details
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.
Relationship*

8. Learner Declaration and Commitment
I agree that the information given in this agreement is true, correct and completed to the best of my knowledge and I understand that DTN Academy has the right to cancel my enrolment if it is found that I have provided false or inaccurate information. I agree that this information can be used to process my data for any purposes connected with my studies or my health and safety whilst on the premises. This also includes any other contractual requirements and, in particular, the disclosure of all the data on this form or otherwise collected about me to the DfE (Department for Education) for the purposes noted in the new Privacy Notice. I also agree with the below points relating to my chosen programme:
- Take appropriate responsibility for my own learning, development and progression
- Attend and undertake training required to achieve the Skills Bootcamp identified in Programme Details in the ILP
- Promptly inform the Employer and/or DTN Academy if any matter or issue(s) arise, or might arise, that will, or may, affect my learning, development and progression
- All times behave in a safe and responsible manner and in accordance with the statutory requirements of health and safety law relating to my responsibilities from time to time
- Comply with the policies, regulations and procedures of my Employer and/or DTN Academy, notified to me from time to time
I agree to the above declaration and commitment*

I agree
Your information may also be shared with other third parties for the above purposes, but only where the law allows it and the sharing is in compliance with data protection legislation. You can agree to be contacted for other purposes by ticking any of the following boxes:

About courses or learning oppertunitiesFor surveys and researchBy PostBy PhoneBy Email
I agree to visual images being used for marketing purposes*

YesNo
Learner Name*

First NameLast Name
Signature*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Skills Bootcamp

1. Learner Information

2. Further Information

3. Emergency Contact Details

4. Qualifications

5. Employment Information

6. Disability, Learning Difficulty and or Health Problem(s)

8. Learner Declaration and Commitment