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North Staffordshire Combined NHS Wellbeing and Recovery College Registration Form

Your personal details

/ /
  • Email
  • Call to phone
  • Text/SMS
  • Post

Emergency Contact We will contact you using your preferred method of contact however if we need to contact you by another method, for example in an emergency, we will use the other contact details you have provided.

About You

  • Acute inpatient care


Please select your top three preferred courses (we will endure try to offer you the courses of your choice, however, due to demand this may not be possible).

Once enrolled, you can also email or call us with your chosen courses at or call on 07971 996653.

We are always expanding our course offer so please let us know if there is an area of interest not currently covered in our timetable

In order for you to join courses we need to be able to send you the links by email or text/SMS.

  • Email
  • Text/SMS
  • Face to face
  • online/zoom
  • Both
Yes No
  • Kidsgrove
  • Leek
  • Newcastle-under-Lyme
  • Stoke

Supporting You

Yes No

A member of staff will contact you to arrange a meeting.

Equality and Diversity Monitoring

Combined NHS Trust has a legal responsibility to pay due regard to: eliminating discrimination, advancing equality of opportunity and fostering good relations between people of different groups.

To help us to do this it is important we have a good understanding of how the courses run by the Recovery College are being taken up. With up-to-date and accurate information, we are able to:

  • Better understand our service users & shape the College's services to meet their specific needs
  • Identify & tackle any issues different people may have when accessing the courses
  • Ensure that people who need our services the most are able to access them

  • Your replies will not be used in a way that identifies you however they will help us to understand how community needs may vary; and helps us make informed decisions on how we develop services and target resources.

    Confidentiality and our promise to you

    Thank you for completing this registration form.

    Attendees of all our courses are expected to:

    • maintain the privacy and confidentiality of other attendees.
    • not to use mobile phones, computers or recording devises during sessions (unless agreed prior to the day).
    • inform us as soon as possible if unable to attend.

    In return the Recovery College will:

    • ensure the data you have provided us above is kept within GDPR regulations. Your personal data will not be shared outside of the Recovery College without your consent; with the exception of if we have concerns about your wellbeing. In all cases our primary aim will be to obtain your permission first.
    • offer courses FREE
    • involve our services users in the development of our college wherever possible.

    By submitting this enrolment form, you are confirming that you have read and understand how your information will be stored / shared by the Recovery College

    Yes No

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