��ࡱ� > �� � � ���� � � ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� c �� R+ bjbj�N�N �� �$�i�$�i�" � �� �� �� � � � h h $ $ $ ���� 8 8 8 8 � t 8 Rq t � � � � � ) � �* � ?+ D �p �p �p �p �p �p �p �s � |v Z �p $ �+ �( | ) �+ �+ �p h h � � � q �/ �/ �/ �+ . h � � $ � �p �/ �+ �p �/ �/ j g � 6 �l � ���� P�3R�� ���� �+ ^ 'i 2 �p "q 0 Rq Yi J �v , � �v d �l �l n �v $ m � �+ �+ �/ �+ �+ �+ �+ �+ �p �p �- � �+ �+ �+ Rq �+ �+ �+ �+ ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� �v �+ �+ �+ �+ �+ �+ �+ �+ �+ � X . : Organisation Details Name of organisation making request Job roleType of organisationEmail addressLocal authority area coveredTelephone numberContact personDate booking form submitted Input Options and Fees* (Please tick or cross) Input for ProfessionalsIn-Person TrainingOnline TrainingIn-Person ConferenceOnline Conference1.Sharing my Story of CSE and Rape � �150 for up to 1.5-hour2.Identifying boys & young men at risk of CSE � �800 per day (9:30am � 4pm)3.Understanding & engaging with boys & young men � �800 per day (9:30am � 4pm)4.Adapting practice and services for boys � �150 per 1.5-hour session5.Reducing the risk of harm when using CSE resources � �150 per 1.5-hour session6.Bespoke professional input.Please give details in the box below Input for Young PeopleIn-Person Small Group(s)Online Small Group(s)In-Person large Group(s)Online large Group(s)1.Male CSE and grooming awareness � �125 a session for up to 1 hour2.Male mental health awareness � �125 a session for up to 1 hour3.Bespoke young people input.Please give details in the box below*Other fees (where applicable) include travel time fees, train fees, taxi fees, accommodation fees and subsistence fees (�30 per night).A tailored quote will be emailed to you If requesting bespoke input please give details below: Requested date(s) for inputStart timeApprox.number of attendeesEnd TimeTarget audience E.g.!police, social care, multi-agency, year 9 boysNumber of times you�d like the input delivered Venue Details (If requested input is taking place online, please provide details of online platform) Full address and postcode of venue Nearest train station to venue Accommodation Details (Only applicable if an overnight stay is required.In most cases Phil will book accommodation) Full address and postcode of accommodation Nearest train station to accommodation Travel Details (Only applicable if input is being delivered outside of Leeds.Please provide details.E.g., Taxi permitted, lift provided) From train station to accommodationFrom train station to venueFrom accommodation to venueFrom venue to train stationTaxi Details E.g.!rank nearby or recommended number Payment/Invoicing Details All invoices will be emailed.Please provide details of who to email the invoice to, along with any purchase order numbers and the address the invoice should be made out to Any Other Information Please turn over for Terms and Conditions (Please read and sign before returning the form) Terms and Conditions (Please read and sign before returning the form) 1.Those requesting ANY INPUT must: Ensure that the person authorised to make payment is aware of the terms and conditions and the payment terms and conditions Visit my website and familiarise themselves with input content prior to making the booking Inform attendees, at least a week before input takes place, the following: The content of the input which some may experience as hard-hitting, uncomfortable and upsetting That educational films may be used which show drug and alcohol use, small amounts of violence, swearing, undressing and scenes which imply sexual abuse, and that some may find these upsetting and uncomfortable to watch That the input may include the use of real-life hard-hitting stories of boys who have experienced abuse, and of adults who have perpetrated abuse That photos of real perpetrators may be shown Provide copies of any handouts supplied by Phil to attendees, and provide their own certificates of attendance if they so wish Manage the administration and promotion of input Understand that the larger the number of attendees, the less interactive the input will be Accept that the PowerPoint used will be amended slightly and emailed to them as a PDF after the input has been delivered, and when payment has been made 2.Those requesting PROFESSIONAL INPUT must additionally: Inform attendees at least a week before the input takes place that the training may highlight various responses made by a range of services and that the input may not be suitable for those who are easily offended and do not like to hear examples of poor practice Inform attendees at least a week before the input takes place the start and finish times, and the importance of starting on time Inform attendees that they may be included in any photos that are taken which may be shared online Inform attendees that they should conduct themselves professionally and respectfully during input delivery 3.Those requesting PROFESSIONAL INPUT 2 and 3 (Identifying boys, and Understanding/Engaging with boys) must additionally: Inform attendees at least a week before the input takes place that part of the training may require attendees to move around the room Allow resources to be stuck on the wall with blu-tak Provide a flipchart stand, flipchart paper and four marker pens Provide a minimum of 12 attendees with a maximum limit of 24 Take responsibility for highlighting housekeeping and evacuation procedures to attendees or clearly communicate this to Phil including what is expected Ensure the space provided is set up for discussions to be held by four small groups 4.Those requesting IN-PERSON INPUT must additionally: Ensure an appropriate space is provided for input to take place Provide the following equipment and facilities ensuring that they are all set up and ready to use: A laptop or computer that has facilities to show a PowerPoint presentation and a film via USB A projector with a clear bulb and good projection Good quality speakers or a good sound system Ensure the laptop provided (if applicable) is compatible with the presentation used by Phil e.g., the version of PowerPoint and the size.Please check with Phil Give Phil reasonable notice if they require him to provide his own laptop 5.Those requesting INPUT FOR YOUNG PEOPLE must additionally: Give attendees the option not to attend, ensuring they are fully aware of the session content at least a week before Ensure that appropriate procedures and support are in place should a young person become upset and/or make a disclosure Ensure that during the input an appropriate professional is present at all times who is aware of input content, will manage the environment, discipline attendees if needed and respond to concerns Ensure that attendees have access to appropriate support and/or someone to talk to immediately after the session in the event that they have any further questions, wish to make a disclosure and/or seek support Ensure that input does not take place before another lesson, as attendees may need time to process, ask questions and possibly disclose 6.Those requesting ONLINE INPUT must additionally: Inform attendees that recording of the online input is not permitted Ensure an appropriate person signs people into the online input and manages any late arrivals 7.Payment Terms and Conditions The only method of payment accepted is BACS The invoice must be paid in full no later than 30 days after the date of the invoice Cancellations made by you less than 30 days prior to the input will not be refunded.You will be invoiced for the full amount quoted/invoiced Cancellations made by you with 30 days� notice or more will be refunded, minus a �20 admin fee, and any costs incurred such as travel/accommodation fees In line with the Late Payment of Commercial Debts (Interest) Act 1998 I reserve the right to claim daily statutory interest at 8% plus the Bank of England base rate in force on the date at which the debt becomes overdue and at any subsequent rate where the reference rate changes and the debt remains unpaid.In addition to this I also reserve the right to charge a fixed sum of �40 as statutory compensation for late payments in line with the Act Names and contact details provided on this form will be stored for up to six years on a password protected laptop, after which time the information including emails, will be deleted.To view my Privacy Notice please visit my website.Please sign below to confirm that all of the above terms and conditions are understood and will be adhered to.The signature can be typed but it must be the signature of the person(s) who is/are requesting the input(s) Name and Job Role (PLEASE PRINT)Signature Date Please send this fully completed form to HYPERLINK "mailto:phil@counsellingwithphil.co.uk" phil@counsellingwithphil.co.uk Please contact Phil for further details: 07780 946568 Once the form is submitted a quote specific to your request will be emailed to you.If you have not received confirmation seven days after submitting the form please check your junk/spam folder and query this.Booking form for commissioning in-house Input Dip.Couns, Registered Member MBACP (Snr Accred) V11July2024 Please complete ALL section of the booking form ! 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