Client Enrolment Form

Title: *

First Name *

Last Name *

Company Name - if applicable

Number of employees - if applicable

Phone Number *

Email Address *

Street Address *

Address Line 2

City *

County *

Post Code *

Age range *

Ethnicity *

Gender *

Do you consider yourself to have a disability? *

Yes

No

Prefer not to say

Are you interested in training for low carbon (including carbon emissions, waste and climate change) in general or are you interested in training for Retrofit/Green Construction? *

Low carbon in general

Retrofit/Green Construction

Business sector

Do you have easy access to the internet? *

Yes

No

Employment Status *

Legal status of company

Legal Status: Other specification

Company Reg No

CIC or Charities Registration Number

The personal information you have provided is required for this support service under the terms of the contractual obligations with our funding partners. Data must be supplied and shared for reporting and research purposes to our Contract Lead Accountable Partner Canterbury City Council.

All information will be held in the strictest confidence and your personal details will not be disclosed to any other third parties without your consent. More detail on our data protection policy and privacy statement can be found at https://www.ytko.com/privacy-policy/.

We would also like to keep you up to date via our bi-monthly e-newsletter with events, news and information on other business support opportunities that can help you. You can opt out of this service at any time.

How did you hear about us? *

Are you interested in receiving our newsletter? *

Yes

No

By signing this form:

You declare you have the legal right to work in the UK.

You give consent for your data to be shared in our reporting and consent for us to hold your personal information in accordance with our contractual requirements.

Signature *

clear

Signature Date * +

18–24	25–29	30–34	35–39	40–44	45–49
50–54	55–59	60–64	65 or over	Prefer not to say

White British	White Irish	White Other	Chinese
Mixed White & Asian	Mixed White & Black Caribbean	Mixed White & Black African	Black or Black British-Caribbean
Black or Black British-African	Black or Black British-Other	Asian or Asian British-Pakistani	Asian or Asian British-Bangladeshi
Asian or Asian British-Indian	Asian or Asian British-Other	Other Other

Part-time	Full-time	Unemployed
Self-Employed	Maternity Leave	Retired

Leaflet	Event	Press	Word of mouth
Referral	Newsletter	Internet	Other