Training Course Booking Form
Any queries on this form, please contact transport@tvcs.org.uk or ring 01264 356808
PERSONAL DETAILS
Title:
Please complete one form per delegate per course. The * sections are mandatory
Gender
Mr [ ] Mrs [ ] Miss [ ]
* Surname:
* First Name:
Year which you passed
your driving test:
[ ] Male
[ ] Female
If you have changed your name in the last three
years, what was your previous name?
* Date of Birth
/
/
A place can only be offered on receipt of a photocopy of your current driving licence. If you
have a modern photo card licence, please enclose copies of both the photo card and the
accompanying paper document.
A photocopy of current driving licence is enclosed. Yes / No (delete as applicable)
* Home Address:
* Home Post Code:
If you have moved house in the last three years, please provide your previous postcode:
Home Tel No:
Mobile:
Personal Email:
ORGANISATION DETAILS
Name of Organisation
Organisation Address:
Are these your employers?
Organisation Post Code:
COURSE
Date and location of course you
wish to attend:
YES [ ]
If no, it is assumed you are a
volunteer driver.
Standard
[ ]
Standard and Accessible
[ ]
Accessible only (already have standard) [ ]
NO [ ]
Who’s minibus would you use for the
driving assessment?
TVCS
[ ]
Other
[ ]
If this is Refresher training, please give date of expiry shown on current Certificate:
Note: MiDAS will, under exceptional circumstances permit Refresher training to be completed up to 3 months beyond the expiry date,
without loss of MiDAS qualification. If your last certificate has already expired, or will have expired more than three months before the
course date, you may need to attend first-timers training. If in any doubt, please check with us before booking.
Payments:
Payment is not required at the time of submitting this initial booking form. However once a course date has been agreed, payment
will normally be required in advance before a place on that course can be confirmed.
Cost of courses
Course
code
Small groups and
state schools
Standard (first time)
S(FT)
£80
Accessible (first time) (includes Standard)
A(FT)
£100
Accessible only
A(Up)
£40
(Upgrade from Standard to Accessible)
Standard (Refresher)
S(Ref)
£70
Accessible (Refresher) (inc Standard)
A(Ref)
£90
An additional fee of £20 will be charged for the use of a TVCS minibus, if that is required.
If in doubt please contact TVCS about the fee which is relevant to your organisation.
Statutory, larger organisations,
customers outside Test Valley,
Academies
£95
£115
£55
Please complete the following table to indicate the fee you believe you will be paying:
Code for Training course from the above table:
Total due:
Cheque Enclosed [ ]
(Please make cheques payable to Test Valley Community Services
Please Invoice [ ]
£85
£105
Hampshire County Council, with Learning Highways, is committed to meeting the requirements of disabled people.
*Do you have a disability or learning difficulty that may affect your learning?
Yes [ ] No [ ]
If you are happy to do so, please indicate the nature of your disability or learning difficulty
Visual Impairment …
Hearing Impairment …
Disability affecting mobility …
Other physical disability …
Emotional/behavioural difficulties …
Other medical condition (e.g.
epilepsy, asthma, diabetes) …
Mental health difficulty …
Aspergers Syndrome …
Temporary disability after illness or
accident …
Profound complex disabilities …
Moderate learning difficulty …
Severe learning difficulty
Dyslexia …
Dyscalculia …
Other specific learning difficulty …
Autism spectrum disorder
Multiple learning difficulties …
Other disability or difficulty, please
specify:
……………………….
Would you like to receive information about the support available?
Yes [ ] No [ ]
Would you like to be contacted by a member of staff to discuss your requirements? Yes [ ] No [ ]
From the options given, please tick the box you feel best describes your ethnic origin:
White:
Asian/Indian
British
Black/African/Caribbean
English/Welsh/Scottish/Northern
Irish/British
Indian
African
Irish
Pakistani
Caribbean
White – Gypsy or Traveller
Bangladeshi
British
White – Any other white background
Chinese
Any other Black/African/Caribbean
background
Mixed / Multiple Ethnic
Group:
Any other
Asian
background
Other ethnic group
White and Black Caribbean
White and Black African
White and Asian
Arab
Other
I prefer not to say
Any other
mixed or
multiple ethic
background
Privacy Notice
How We Use Your Personal Information
The personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when
needed, the Department for Education, including the Education Funding Agency to meet legal responsibilities under
the Apprenticeships, Skills, Children and Learning Act 2009, and for the Agency’s Learning Records Service (LRS) to
create and maintain a unique learner number (ULN). The information you provide may be shared with other
organisations for education, training and employment-related purposes, including for research.
Further information about use of and access to your personal data, and details of organisations with whom we
regularly share data are available at:
http://skillsfundingagency.bis.gov.uk/privacy.htm
Tick this box if you do not wish to be contacted in respect of surveys and research.
Tick this box if you do not wish to be contacted about courses or learning opportunities.
Tick this box if you do not wish to be contacted by post.
Tick this box if you do not wish to be contacted by telephone.
Tick this box if you do not wish to be contacted by e-mail.
I have read the data protection statement above and consent to the information I provided above and
on my booking form being used for these purposes.
Please tick to confirm
Date: