Taster Day Enrolment Form

Please complete the form with the details of the young person wishing to attend the taster day

Course Name	Start Date	End Date	Site
Rodbaston Taster Days - Routes	18/02/2025	18/02/2025	Rodbaston Campus

Section 1: Personal Details (1 of 2)

Surname (Family Name)

First Forename

Date Of Birth

Gender

Contact Number (Home Telephone)

Mobile

Email Address

Email Address (enter again)

How did you hear about us?

What was the last or present school you attended? - Please Leave Blank Or Select Blank option ( first option in Dropdown ) If your School is not listed

Ethnic Group

Section 1: Personal Details (2 of 2)

Please enter your postcode or partial address below:

Search:

Please Select your address from the list below

Property/Street

Locality

Town

County

Postcode

Section 2: Next of Kin / Emergency Contacts

Please provide details of up to two contacts. Learners aged 18 or younger must provide the details of at least one parent/guardian.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone number

Emergency Contact Email

Do you live with this person?

Do you want to add another contact?

Yes

Second Contact Name

Second Contact Relationship

Second Contact Phone number

Second Contact Email Address

Do you live with this person?

Section 3: Supporting you

Do you have any support needs?

Section 4: Terms & Privacy

Consent for Image Recording, Storage and Use: The College may record still or moving images of students for the following uses: learning materials, photographs or video footage (handouts, work books, etc) and e-learning materials e.g. leaflets, brochures, videos, website, poster, etc used to promote the college. The Data protection Act 2018 says that we need your permission to store and use still moving images in which you are included. By signing below you are agreeing to us using these in the ways indicated. You can at any time withdraw permission for any time, should you wish to do so please email enquiries@southstaffs.ac.uk

- I confirm I have read and understand the information above.

Please sign and continue to finish enroling - you can use your mouse or a drawing pad, dont worry about recreating your current signature

Signature