Curry by Numbers Sign up Form

Inked– Sign up Form

Please complete the details below. This will help us to make sure that we do our best to support your needs and help you to get the most out of the course.

Address

Phone No.

I find it very difficult

There’s some things I find hard

How would you rate your I would like to brush up on my skills reading skills? I feel quite confident

I feel very confident

Not at all confident

A little confident How confident are you at writing? Quite confident

Very confident

Not at all confident

How confident are you at using A little confident computers? Quite confident

Very confident

What do you hope to get out of

DATA LABEL : PROTECT To gain awareness of design

To research and make 3 designs

To gain a qualification

To gain confidence coming on the course? (Tick as many boxes as you like) To meet new people

To improve your literacy skills

Other (give details)

You will get support from our tutors with all the activities that we do. However, you may feel you need some extra help. What additional support, if any, will you need to come on the course?

Reading support

Writing support

A crèche From our tutors Help with using computers and technology

Any other help (give details)

Someone to support you to come on your first day From others (including key workers) Help getting to and from the group each week Any other help (give details)

Please tell us about any additional support needs, disability or medical condition that we should be aware of. (e.g. do you need help with learning, mobility hearing etc?)

DATA LABEL : PROTECT Please tell us about any allergies that you may have.

Key Worker Contact Details (if relevant) Name

Organisation

Phone No.

Thank you

DATA LABEL : PROTECT