FOR OFFICE USE ONLY
RECEIVED BY:
PROGRAMME:
DATE RECEIVED:
CONFIRMED:
Y/N
Training Booking Form
Please complete all relevant sections in BLOCK CAPITAL LETTERS, sign the form and send to ECO-UNESCO. Contact details below.
PART 1: PARTICIPANT DETAILS
Individual’s Details
Your Organisation’s Details (if applicable)
First Name:
Name of
Organisation:
Last Name:
Home Address:
Organisation
Address:
Mobile Phone:
Email:
Organisation
Phone:
Organisation/Work
Mobile:
Organisation Email:
Date of Birth:
Organisation Fax:
PPSN (Required for FETAC
Organisation
website:
Home Phone:
courses only)
Emergency Contact Name and Phone number:
Gender:
Age:
Male
<10
Female
10-14
Prefix:
15-18
Mr
19-21
Ms
22-24
Dr
25 or over
PART 2: PROGRAMME REQUESTED (Please tick the course/event you wish to register for)
Education and Training Programmes and Services
Please refer to www.ecounesco.ie for a list of our next scheduled short training courses
Please state the date of the course you wish to book for:
___________________________________
Short Courses:
Environment Education: Trends and Developments
Environmental Education Curriculum Links
ECO-Community Garden Training
Leadership and Strategic Sustainable Development Training
Youth Work and Sustainability Training
Peer Education and Sustainability Training
Drug Prevention Training for Trainers (an alternative approach to Drug Prevention)
ECO Award – for organisation working towards sustainability
ECO-Watchers one-day Training for teachers and leaders
FETAC Awards Ceremony/Alumni Network meeting
Young Environmentalist Awards 6 Steps To Success
Youth Leadership and ECO Skills
Please state the date of the course you wish to book for:
___________________________________
Accredited Courses:
ECO-UNESCO’s Introduction to Sustainable Development (FETAC Level 5)
Intensive
ECO-UNESCO’s Community Development (FETAC Level 3)
Junior ECO-Watchers EPV Accredited Teacher Training Week (Dept. of Education and Skills)
ECO-UNESCO │The Greenhouse │ 17 St Andrew Street │ Dublin 2
T: +353 1 6625491│F: +353 1 6625493 │E: info@ecounesco.ie
www.ecounesco.ie
Template Version: November 2011
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10 week
PART 3: EDUCATIONAL DETAILS (required for FETAC accredited modules only)
Primary
Secondary to Junior Certificate
National Vocational Certificate
Secondary to Leaving Certificate
Third Level
The preferred entry level for FETAC level 5 modules is Leaving Certificate or National Vocational Certificate Level
1, and/or relevant work and life experience. Further details of entry criteria are available on request.
Please describe any other learning, interest or background you have that is relevant to the subject; through
studies, work or life experience. (Please enter description below)
…………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
PART 4: OTHER INFORMATION
1. Have you any special requirements/disability/allergy that we should know about?
If yes, please outline the supports you require. (Please enter your requirements below)
Yes
No
…………………………………………………………………………………………………………………………….
2. Have you participated in an ECO-UNESCO event in the past?
If yes, please specify which course/event. (Please enter course/event below)
Yes
No
……………………………………………………………………………………………………………………………
3. How did you hear about our training programmes? (Please tick the options that apply)
Email Promotion
Leaflet
Internet (Please state which website on dotted line below)
Newspaper
Word of mouth
Other (Please specify on dotted line below e.g. radio
……………………………………………………………………………………………………………………………
4. Are you a member of ECO-UNESCO?
Yes
No
If not, would you like to become a member?
Yes, please send more information
No
PART 5: PAYMENT INFORMATION
ECO-UNESCO accepts payment by cheque, postal order or bank draft payable to ECO-UNESCO or you may pay
in cash by calling to our offices at 17 St. Andrew Street, Dublin 2.
FETAC:
€240
€220 C&V Sector
€200 Members/Unwaged*/under 25s
EPV Accredited Teacher Training Week:
€90
ECO Award and Peer Education & Sustainability courses:
€80
€50 C&V Sector
€45 Members/Unwaged*/under 25s
Short courses:
€90
€80 C&V Sector
€70 Members/Unwaged*/under 25s
€100 2 participants from same organisation (Applicable to short courses only)
FREE Event:
(Please tick if you are attending a FREE ECO-UNESCO event)
*Please Note: For unwaged, evidence required e.g. medical card or receiving social welfare
PART 6: TERMS & CONDITIONS
Booking and Payment: Your place will be reserved only when a signed booking form has been received by post, email or fax.
Your place will be confirmed when full payment is received. Full payment is due 5 working days prior to course
commencement. We cannot guarantee your place unless payment has been received. We will accept a written cancellation
of confirmed bookings up to 3 days before course commencement. However, fees will not be reimbursed if written notice is not
received. Cancellation fee applies.
Data Protection and Privacy: We will not share your details with any third party with the exception of FETAC if appropriate. Your
details will be maintained within our participant files and we may contact you in the future about other ECO-UNESCO services.
All participants are signed up to our monthly e-bulletin newsletter. You may unsubscribe at any time.
Policy on the use of photographs and video: ECO-UNESCO may use images and/or video from our activities for publications,
promotional purposes and FETAC award requirements. The signature of a parent or guardian is required for young people
under 18 years of age.
Medical Assistance: By signing this form, you are authorising ECO-UNESCO to undertake appropriate first aid assistance in case
of injury, accident or medical emergency.
PART 7: PARTICIPANT AGREEMENT
PART 8: PARENT/GUARDIAN AGREEMENT
(if participant in under 18 years of age)
Signature:
____________________________________________
Date:
____________________________________________
I understand and accept all the Terms and Conditions of this
contract (the above signed)
Signature:
_________________________________________
Date:
_________________________________________
I understand and accept all the Terms and Conditions of this
contract (the above signed)
ECO-UNESCO │The Greenhouse │ 17 St Andrew Street │ Dublin 2
T: +353 1 6625491│F: +353 1 6625493 │E: info@ecounesco.ie
www.ecounesco.ie
Template Version: November 2011
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