EXPLORE 2024 Enrolment Form
Thank you for taking the time to complete our Explore 2024 programme.  

Please note, Explore is a classroom style course.  The workshops are delivered face-to-face in a classroom environment.  After registering, you will receive a phone call from Desiree, our co-ordinator, on the number you provided for a quick chat. 

To register for an upcoming course, please complete the form below and click "Submit" at the bottom of the form.  
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Email *
Are you: *
If you are a Referral Agency, applying on behalf of a participant, please indicate below the type of support required - tick all that apply  (Please ignore this question if you are applying as a Self-Referral).
If you are a Referral Agency applying on behalf of a participant, please include some background information on the participant and the date, name and referral organisation and then go on to complete the rest of our referral application form.  Thank you!
As a Self-Referral applicant, please complete the following questions:
Starting date of your Explore course:

Summer 2024 Dates: Wednesdays, 5th, 12th, 19th & 26th June and 3rd, 10th July at the Twickenham United Reformed Church, First Cross Rd, TW2 5QA)


Autumn 2024 Dates: Tuesdays, 17th , 24th September and 1st, 8th, 15th & 22nd October at the Kingston United Reformed Church, Eden Street, Kingston, KT1 1HZ)

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Your full name:
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I prefer to be called:
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Date of birth:
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Please select an option below: *
I identify as: *
Please describe your ethnicity: *
Please share your address including post code below: *
Please tell us your Borough: *
Main contact number:
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Do you consider yourself to have a disability or learning difficulty?
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If yes, please could you provide some details:
Do you have any health or medical conditions Shepherd’s Star should be aware of:
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If yes, please could you provide some details - and, if appropriate where you receive your support from eg: GP, RB, Mind Wellbeing etc:
What is your employment status?
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When were you last employed? *
Do you have a specific skill, eg. gardening, DIY, cooking etc.?
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Please share with us a short term goal of yours:
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Please share with us a long term goal of yours:
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Have you found any of the following to be barriers to your achieving your goals in life? Please tick any that apply. *
Required
How did you hear about Explore?
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What interests you in the programme?
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What do you hope to gain from Explore?
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As part of the Explore programme, we share a communal lunch together.  Please could you let us know if you have any allergies we need to be aware of - or food you are unable to eat: *
Declaration:
I commit to complete the Explore 2024 programme and fulfil all the workshop tasks to the best of my ability.

I declare that the information given in this form is true. I give my consent to Shepherd’s Star to record and store my personal data.
Date: *
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Signature *
FYI
The information provided by you on this form will be stored either on paper records or a computer system in accordance with the Data Protection Act 1998 and will be processed solely in connection with your Explore programme registration.
Privacy Notice & GDPR
Your information will be securely destroyed after it is no longer required for these purposes.  Your information may be shared with third parties for education, training, employment and well-being related purposes, including for research. 

This will only take place where the law allows it and the sharing is in compliance with the General Data Protection Regulations Act 2018.

Further information about use of and access to your personal data, details of organisations with whom we regularly share data, information about how long we retain your data, and how to change your consent to being contacted, please contact our Safeguarding Officer, Desiree Shepherd.

Registered Charity Number: 1196520
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