New Referral

Complete the following form to submit a request for training at Nexus.

Privacy Statement

NEXUS NI processes identifiable personal data for the purpose of maintaining the operations of its business. Any personal data you provide to NEXUS NI through any means, verbal, written, in electronic form, and through the NEXUS NI website, will be held and processed in strictest confidence, only in relation to purposes relevant to your request, and in accordance with the Data Protection Act 2018, and the NEXUS NI Privacy Policy.

Client Consent Form

By signing this document, you give NEXUS NI consent to process and store your information in relation to your request for training and early intervention and prevention services, and any subsequent service you may receive from NEXUS NI.

All information you provide us is processed and stored as securely as possible. Any hard copies are scanned and uploaded onto our database system and hard copies are destroyed in confidential waste. Unfortunately, internet communication is never completely secure, and for this reason we do our best to ensure we abide to highest standards of data protection. We ask you to recognise that any transmission of information you communicate to us over email is at your own risk. Once we have received your information, we will proceed to store it safely in order to prevent unauthorised access.

 

 

Client

Defaults to today’s date
Enter your Organisation/School Name
Select organisational type.
Please provide your Organisation's child safeguarding officer details for contact if needed.
Please select a workshop/training
Enter your job title
Enter forename
Enter surname
Enter organisational address.
Enter full postcode (e.g BT3 9DT or SW1A 1AA)
Enter contact number
Enter an email address.
Please select a how did you hear about us option

 

 

Please provide any relevant details that may help us assist you.
Please provide details of any days or dates you would prefer
Please provide any additional information you feel relevant
Please enter the number of sessions planned
We recommend 90 mins for optimal learning and a safe space for discussion.
Please enter the age range of the participants involved
Please enter the approximate number of participants per session
Select the preferred delivery method
Yes No
Yes No
Yes No

Consents

How we use client information

We may use client information to carry out our obligations arising from any contracts entered into by the client and us. We promise to keep your details safe and secure. We will not share your information with third parties for marketing purposes. We may contact you to let you know about other services, events or for evaluation purposes.

The circumstances when details can be shared include:

  • When a person discloses criminal activity, or knowledge of criminal activity, this includes statutory obligations.
  • When it is necessary to uphold child protection laws.

Your responsibility

We would ask that you keep us informed (by email, telephone, or in writing) of any changes in your contact information or relevant organisational data so that we may have our records up to date at all times. If you wish to withdraw your consent please contact us (by email, telephone, or in writing). You have the ‘right to be forgotten’, which means you can request the deletion or removal of your data where there is no compelling reason for its continued processing.


GP/3rd Party Consents

I consent that you can share details with my GP and other 3ʳᵈ parties

Communication Consents

Tick your preferred methods of consent from the list below. Please TICK ALL that apply (a minimum of one must be selected)

I consent that I'd like to hear from you via email

I consent that I'd like to receive phone calls from you and you can leave voice messages

I consent that I'd like to receive SMS texts from you

I consent that I'd like to receive letters from you