First Aid Medical Services Course Application Form

Please carefully read our policy on data held by First Aid Medical Services

GENERAL DATA PROTECTION REGULATIONS

First Aid Medical Services has a duty to maintain accurate records of candidates’ details and assessments for verification and legal purposes. This data will not be shared with third parties without your consent, unless required to do so for legal purposes. Data will be held for a period of up to two years after the expiry date of the qualification, or for a maximum of five years from the course completion date (whichever is greater). Please indicate below to confirm that you agree to your personal data (inc. the information on this sheet and any completed worksheets and assessments) being held by First Aid Medical Services. This agreement is requested under the provisions set out within the “General Data Protection Regulations 2016/679)”.

I agreeI Do NOT agree

Unfortunately, First Aid Medical Services is unable to accept on a course any candidate who declines this request.

Please read the reasons set out in the above policy.

I give my consentI Do NOT give my consent

Course Reference*

Select or Enter the Unique Course Reference No.

Candidate Number (if known - otherwise please leave blank)

Please enter your candidate number if known

Course Title*

Select your Course Type from the dropdown list

Course Date*

Date

Your Full Name (as shown on your Photo ID)*

Mr/Mrs/Dr...First NameLast Name

Date of Birth*

Date of Birth

Email Address:*

Confirmation EmailPlease confirm your email address

Address*

House No / Name and Street Address

Address Line 2

Town / City

PostcodeCountry

Contact Daytime Number:*

Area CodePhone Number

Contact Mobile Number:*

Area CodePhone Number

Some courses require an element of physical activity and also require candidates to participate in discussion and complete written exercises.

I Do NOT require reasonable adjustmentsI DO require reasonable adjustments

Please give details of any reasonable adjustments required:*

Please note, there may be some aspects of training (such as kneeling/sitting in order to deliver effective CPR) that must be completed. Should you have any queries concerning reasonable adjustments, please contact us prior to registering for the course, so that we may discuss your query.

Due to the physical nature of some courses, it is advisable to consult your doctor if you have any pre-existing medical conditions or injuries, or you are pregnant, prior to taking part on the course.

NoYes

I Confirm

The information I have given is accurate to the best of my knowledge. I have read and understood the information provided on this online application form. I understand that this course may include some physical activity and that First Aid Medical Services cannot be held liable for any injury caused or aggravated through my participation in the course. (Please tick to confirm.)