<p> THURROCK CHILDREN’S PARTNERSHIP STAY SAFE INTER-AGENCY TRAINING GROUP APPLICATION FORM 2013</p><p>NB. ALL SECTIONS OF THIS FORM MUST BE COMPLETED, PLEASE USE BLOCK CAPITALS (this form has two pages)</p><p>COURSE TITLE Child Protection – Growing a Questioning Culture – Two Part Course – Please note you must be able to attend both parts of this course.</p><p>COURSE DETAILS Please indicate your preferred date</p><p>Part 1 – Thursday 30th January – 09.30 till 12.30, Part 2 – Thursday 20th March 13.30 till 17.00</p><p>Part 1 – Thursday 30th January – 13.30 till 17.00, Part 2 – Thursday 24th April 09.30 till 12.30</p><p>Part 1 – Thursday 20th March – 13.30 till 17.00, Part 2 – Thursday 24th April- 13.30 till 17.00 </p><p>Culver Centre, Daiglen Drive, South Ockendon, RM15 5RR</p><p>NB Please arrive from 09.00 onwards, ready to start at 09.30 (Lunch is not provided on this course). Please arrive at 13.00 onwards, ready to start at 13.30</p><p>FULL NAME FIRST NAME: (this is how it will appear on your certificate) LAST NAME:</p><p>JOB TITLE IN FULL</p><p>NAME OF EMPLOYING OR VOLUNTEERING ORGANISATION My organisation is (Please circle one of the STATUTORY / VOLUNTARY / CHARITABLE / PRIVATE or COMMERCIAL following options) If charitable please provide charity number: </p><p>Department/Team </p><p>AGENCY ADDRESS (where you are based)</p><p>POSTCODE: Email DAYTIME CONTACT No.</p><p>To attend this training participants must have attended child protection training in the past 3 years</p><p>Have you attended child protection training in the past 3 years? YES / NO</p><p>If ‘YES’ please provide the date on which you attended: </p><p>Please return completed applications to: either [email protected] OR Toni Archer, CO1 1st Floor, Civic Offices, New Road, Grays, RM17 6SL How will this training support your Personal Development Plan/Job role?</p><p>Line Managers Name Line Managers Job Title</p><p>If you require any additional resources or support in relation to either a physical disability of learning need in order to attend this training please provide details here:</p><p>Both the applicant and their Line Manager must read and sign the following before submitting their application.</p><p> I can confirm that this training is relevant to the applicants role and will assist in meeting objectives in their Personal Development Plan  On behalf of my agency I accept that the agency will be liable for a cancellation fee of £50 if the named person does not attend or cancels the place without sufficient notice. Sufficient notice is deemed to be, notifying the training coordinator to whom this form was returned at least 3 working days prior to the training event.</p><p>Applicants signature: Line Managers signature:</p><p>Date: Date: Managers Address if different from above:</p><p>Postcode:</p><p>Please return completed applications to: either [email protected] OR Toni Archer, CO1 1st Floor, Civic Offices, New Road, Grays, RM17 6SL</p>