Digital Dishes of Change

Support Worker Name*

First NameLast Name

Phone Number

Area CodePhone Number

Full Name*

First NameLast Name

Date of Birth

Date

E-mail*

Full Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

How many people are in your family?*

What sort of smart phone or device to have?

Do you check and use any of the following platforms or websites?

EmailsYou TubeWhats AppNONE

If you are doing this project as a family. please provide their names and ages.

Do you have any learning disabilities?*

YesNo

You answered yes. Can you please give us more information about the disability?

How did you hear about us?*

Other

Does anyone in your family have any food allergies or preferences?

Each week we will deliver you a food parcel conatining all the ingredients you need to be apart of the course, You will need to log on to a website to watch the videos and complete health and safety questions.

Or we can deliver you a weekly food parcel to help you and your family.

Which programme are you interested in being involved with?

Digital Online Food Course/ No Food BankOnline Programme with Food BankFood Bank Only

Would you like to obtain a free Level 2 Food Safety Qualification, provided by NCASS

YESNoMore info needed

By signing here you agree to being contacted by partners involved with the project only. Your personal details will not be shared outside to anyone outside of the project. Signature

Clear

Key Information

PLEASE NOTE To access our online tutorials you will need access to a laptop, desktop computer or tablet. You will need to watch videos, send emails and complete online work.

Lead Applicant Details:

Key Information

**PLEASE NOTE** To access our online tutorials you will need access to a laptop, desktop computer or tablet. You will need to watch videos, send emails and complete online work.

Lead Applicant Details:

PLEASE NOTE To access our online tutorials you will need access to a laptop, desktop computer or tablet. You will need to watch videos, send emails and complete online work.