Get involved: registration form

Please complete the form below to register your interest in becoming an Involvement Partner with Bradford District Care NHS Foundation Trust. An Involvement Partner is a service user/patient/carer or member of the public who wants to get involved with BDCFT and make a difference. Once we have your details we will be in touch by your preferred contact method to complete our i2i session (Induction to Involvement) so you can become an Involvement Partner. This form lets you tell us know the kind of things you are interested in. Being involved is a type of volunteering so can be a great experience for students and other people to help develop valuable skills and knowledge for work. It can be fun and rewarding too! You can take part when it suits you, as much or as little as you want. We will usually pay your travel expenses and other out of pocket expenses. If you need extra support to get involved, we will do our best to help you with that. For example an interpretor or support if you are disabled If you would like help to fill in this form please email us on involve@bdct.nhs.uk or call 01274 228298. If you need this information in another format or language, please contact us or ask a member of staff in the service you are using.

Title*

Name*

First

Last

Address*

Street Address

City

ZIP / Postal Code

Telephone number*

Please select your age group*

under 18
19 – 25
26 -35
36 – 45
46 -55
56 – 65
66 – 75
76+

Email address

To reduce costs, it would be helpful if we could by email. Please leave blank if you do not wish to be contacted by email.

Connection to the Trust (please select all that apply)*

patient/service user
carer
other e.g. organisation or group
no connection

Please select the areas of health and the Trust that you are interested in*

How will my information be used?

When you send us this form you are giving us permission to contact you with information about ways to get involved

We will store you personal information securely, in line with NHS guidelines
We will only share your information if necessary and we will always ask your permission
You can remove your name from our contact list at any time.

Involvement Partner registration form

How will my information be used?