Inclusion Project Community Joining Form

1
Details of the person filling in this formWho are you?
Full Name
Relationship to the Participant, if you are not the Participant.
Full Name of the person we will be corresponding with (if different than above) and relationship (if different than above)
Email Address (this is the email we will correspond with in regards to this referral)
Telephone Number (this is the number we will correspond with in regards to this referral)
2
Details of the person wishing to access The Inclusion Project.Who is the Participant? ('Participant' is the name that we use for the people that use our service).
Full Name
Email Address
Telephone Number
3
Participant's NameThis is needed in order to include the participant's name in the title of the PDF file
4
Address of the Participant* This field is required.We need to know this to inform which location of The Inclusion Project the Participant would be able to access.
Street Address
Street Address Line 2
City
Country
Post Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Calculation
6
Tie Break ANeeded to resolve a crossover in franchise areas for Post Code districts HP[1..4] and HP[17..23]
7
Tie Break BNeeded to resolve a crossover in franchise areas for Post Code districts WD[3..7], WD[17..19] and WD[23..25]
8
Tie Break CNeeded to resolve a crossover in franchise areas for Post Code districts AL[1..10], CM21, CM23, EN[6..11], and SG[1..17]
9
Area
10
Will the Participant in question be over the age of 18 years old when attending their first session with The Inclusion Project?* This field is required.The Inclusion Project is unable to support anybody under the age of 18 years old.
YESNO
11
What type of session is the Participant interested in attending/finding out more about?
Day Sessions (7 hour sessions)
Evening Sessions (4 hour sessions)
Day and Evening Sessions
12
Any other information you would like to share at this point?We will gather a lot more information at the initial 'Meet and Greet' assessment, this form is just a short introduction. Thank you.
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Normal
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Ok
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