Woodlands – Pinc Group

Click here to download the prospectus.

Taster day Booking form

Student Details:

First Name *

Last Name *

Date of birth *

Preferred To Be Known As

Pronoun

Home Phone Number *

Mobile Number *

Student Email *

Address *

I can confirm that I/The Student can manage a 5 day timetable?*
YesNo

If you are aged between 16 and 18 years of age, have you achieved the required grades in GCSE English and Maths? *

YesNo

Please choose your campus *

Wolseley Centre, Staffordshire Wildlife TrustBickley Farm, Malpas, Cheshire Wildlife TrustStirley Farm, Huddersfield, Yorkshire Wildlife Trust

Proposed Start Date

Local Authority SEND case worker

Your Local Authority

Social Worker (If you have one)

Known SEND need. Tick all that apply *

ADHDAnxietyASC/AutismCerebral PalsyDyslexiaDyspraxiaEpilepsyHearing impairmentMental health difficultiesPhysical disabilityVisual impairmentOther

Your wildlife and countryside interests *

Does the young person have an EHCP/ Statement (Wales) *

YesNo

Does the young person have any Safeguarding incidents/issues and/or a Risk Assessment *

YesNo

How did you hear about Pinc Woodlands? *

LinkedInFacebookInstagramX.comEmailCareers AdvisorLocal AuthoritySocial WorkerHealth ProfessionalParent or Carer GroupOther

Parents / Carers / Corporate Parent:

First Name *

Last Name *

Mobile Number *

Email *

Relationship to Student

Address (if different) *

Emergency contact details if different from above:

Name

Relationship to Student

Telephone

Education History:

Current School or College

Address

Date From / To

Most Recent Attendance (Average)*
Below 20%20% - 50%50% - 80%Above 80%

Wellbeing*
GoodSome ConcernsReq. Intervention

Overall Attainment*
ExcellingSome ConcernsNo Progress

Qualifications:

Subject 1

Grade or Expected Grade

Date (Year) Completed/Expected

Subject 2

Grade or Expected Grade

Date (Year) Completed/Expected

Subject 3

Grade or Expected Grade

Date (Year) Completed/Expected

Subject 4

Grade or Expected Grade

Date (Year) Completed/Expected

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Is the young person currently in education?
YesNo