Active Leader and Junior Active Leader Trainer Accreditation Course Registration

Course Code *

Trainer First Name *

Trainer Middle Name

Trainer Last Name *

Trainer D of B *

Trainer email address *

Trainer mobile number *

Photo ID *

No file chosen

Please upload Photo ID (e.g. passport, driving license)

Street Address *

Address Line 2

City *

County *

Post Code *

Reference Name *Name of a person we may contact for a reference who is not a close relative

Reference Email Address *Email address of the person we may contact for a reference

Reference Phone Number *Phone number of the person we may contact for a reference

Accept privacy policy *Yes, I agree with privacy policy.

Data Protection *YesBy checking this box you confirm that we may contact you using the contact details you have provided and that we may hold this information in accordance with our Privacy Policy.

Active Leaders requires all accredited trainers to have a current, enhanced DBS Certificate. If you have registered for the upgrade service you may enter the DBS Number in the box provided. Otherwise, please upload a copy of your DBS Certificate. *DBS CertificateDBS Number and Date

Upload enhanced DBS certificate *

No file chosen

DBS Number *

DBS Date *

Please confirm you have an up to date first aid at work certificate *YesNo

Upload first aid at work certificate *

No file chosen

Safeguarding Training Date

Date of your most recent safeguarding training

Safeguarding course/qualificationPlease specify the safeguarding course / qualification.

Pre-accreditation experienceYesNoPlease indicate whether or not you have the pre-accreditation experience listed in the guidelines (https://www.activeleaders.co.uk/wp-content/uploads/2022/02/Pre-Accreditation-Experience.pdf) and can supply evidence if requested.

Organisation or School *Please indicate the organisation, school or entity you are employed by, or if you are not employed, your current work status.

CoursePlease select the trainer accreditation course you are registering for

Cost of course

VAT

Total cost

Pay for course now? *YesNoSelect 'Yes' to pay now via credit/debit card.

Credit / Debit Card *

Please enter your card details. Only UK cards are permitted. The card will be debited with the value shown in the 'Total cost' field.