Enrolment Form (please complete all boxes as not doing so could delay your enrolment) Enrolment Form Full Name*Date of BirthDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AddressEthnic OriginWhite BritishWhite OtherMixedAsian / Asian BritishBlack / African / CaribeanOther ethnic groupPhone No.Email Do you consent to the recovery college contacting you about future activities?*YesNoWe never pass your information to anyone else and you can change your mind at any time, just let us knowGenderMaleFemaleTransgender MaleTransgender FemaleIntersexOther e.g. non-binary, gender fluid, etcPrefer not to sayAre there any safety or risk issues that we need to know about e.g. have you ever been considered a risk to others?Do you have any specific health or other needs that we need to consider when you become a student?How did you hear about Kind Mind: Recovery Community?Emergency ContactMust be completed. Next of kin, family member, close friend.Full Name*AddressPhoneRelationship to youIn the case of an emergency, do we have your consent to contact this person?YesNoProfessional SupportMust be completed. Support worker, GP, CPN, etc.Full NameAddressPhoneRelationship to youAfter discussing with you our concerns and we still feel it is in your best interest, do we have your consent to contact this person?YesNoDisclaimer I consent. I confirm that by applying for a place in the Recovery Community I consider that I am well enough to participate and will take personal responsibility for my well-being. I also confirm that I have read and understood the Code of Conduct and agree to abide by it.