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Independent Parental Supporter Programme Application Form

If you are intested in becoming an Independent Parental Supporter please fill in the application form below and a member of our team will be in touch shortly.
(* Please note all fields marked with a (*) are required fields which must be filled in)

 

First Name:*

 

  

Surname:*
 

Address:*

 
 
Postcode:*
 
Telephone:*
   
Email:
 
Date of Birth:
   
Ethnic Group:
   
Ability Status:
   
Employment Status:
   
How did you hear about the IPS scheme:
   
To travel, do you use:

Car
Bicycle
Motorcycle/Moped
Public Transport

   
Do you have any special requirements e.g. diet, learning difficulties or access that could affect participation in the training programme or your role as an IPS?    Yes    No
(It is helpful for us to know to enable us to support you.)
If yes give details:
   

When can you generally be available to carry out the role following training?
(please tick all the boxes when you are available)

Weekdays:
 Mornings Afternoons Evenings

Saturdays:

 Mornings Afternoons Evenings
Sundays:
 Mornings Afternoons Evenings
 
When are you not available?
   
Please outline any relevant experience that might help you carry out the role:
   
Please note below the names and addresses of two people we may contact for a character reference: (not relatives)
1. 2.
   
Do you have a Police Record: Yes No
   

Under the Rehabilitation of Offenders Act 1974 if you have substantial access to people younger than 18, you must declare convictions, even if they are spent. Having a criminal record will not automatically debar you from doing voluntary work.

You will be asked to complete a police clearance form on completion of the programme.


Please tick this box to confirm you have read our privacy policy.