Programme Application Form
Programme Title
Programme Start Date
Time
Format
Please Select
In Person Training
Virtual Training
Trainer
Status
Please Select
Attending
Attended
Cancelled
Attendee Details
Name
*
First Name
Last Name
Email address
*
Confirmation Email
example@example.com
Contact Number
*
-
Area Code
Phone Number
This programme is only open to parents residing in the Belfast Health & Social Care Trust & Southern Health & Social Care Trust Area. Please confirm if you meet this criteria and that you are able to access the course online via Zoom.
*
Yes
Please confirm you are experiencing child to parent violence.
*
Yes
Provide the age(s) of the relevant child/children
*
We’d love to keep you informed via email about future training courses that may be of interest to you. If you’d prefer NOT to receive these emails, please tick this box.
Please DON'T send me future training opportunities
I confirm I have read the
booking terms & conditions
.
Yes
Submit Application
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