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Course*

Introducing Healthcare Chaplaincy 8 March 2025 (5 days F/T P/T and Hon. Chaplains) Introducing Healthcare Chaplaincy 10 March 2025 (3 days Volunteer Chaplains Introducing Healthcare Chaplaincy 18 October 2025 (5 days F/T P/T and Hon. Chaplains) Introducing Healthcare Chaplaincy 20 October 2025 (3 days Volunteer Chaplains)

Chaplaincy Field*

Acute General Health Care Mental Health Hospice

Name*

Surname*

Gender*

Ethnicity*

Do you have a disability?*

Please identify if you have any specific requirements or need access to particular facilities to attend the course*

Is your role*

Full-time Part-time Hon.Chaplain Volunteer

Faith / Denomination*

Name of Trust*

Year of Appointment to Trust*

Address 1*

Address 2*

Address 3*

Post Code*

Country*

Contact Telephone Number*

E-mail address:*

Dietary Requirements*

Funding*

Self-funding Employer funding sponsored

Name of Employer/Organisation

Employer / Organisation Purchase Order No

You may be required to supply us with a Purchase Order Number by your trust/organisation prior to invoicing

Employer / Organisation Finance Address*

Finance e-mail address*

Finance contact telephone number*

How did you first hear about this programme?*

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