Pre-Course Form
This form is completed prior to attending a Dementia Interpreters Course.
Sign in to Google to save your progress. Learn more
Full name. *
E mail address: *
Your company name. *
Date of course *
Time of course *
Please tick any of the following medical conditions you have. *
Should you tick any of the below conditions, you must make the trainer aware prior to the commencement of the course.  The Dementia Interpreters course uses equipment that will reduce your ability to communicate and move.  You should only volunteer to take part as a person with dementia (PIC) if you are happy to have these abilities removed.  You take part at your own risk and Dementia Interpreters Ltd or any other associate parties cannot be held responsible for any persona injury arising from the products used during this course.
Do you give us permission to share the information you have provided here with your facilitator to ensure your Dementia Interpreter course is delivered safely? *
Do you give us permission to contact you via e mail regarding this course or any other associated products or courses available though associated companies of Dementia Interpreters Ltd. *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy