Register To Rent

Step 1 of 2

Title

First Name *

Surname *

Date Of Birth *

Address *

Post Code *

Phone Number *

Email *

Website Address

Services Offered *

Do Your Services Require CQC Registration *

PLEASE NOTE: DO NOT ADD OUR LOCATION ADDRESS ONTO ANY CQC REGISTRATION FORMS WIHTOUT PRIOR AGREEMENT. ROOM RENTAL MAY NOT BE POSSIBLE IF YOUR SERVICES REQUIRE YOU TO BE CQC REGISTERED.

Relevant Qualifications *

Upload Qualification Certificates / Documents *

Upload Qualification Certificates / Documents

Upload Professional Body Certificates / Documents

DBS Certificate (If Working With Young Adults/Children)

Upload ID Documents / Passport Or Drivers License *

Current Insurance Certificate *

Have You Had Any Insurance Claims Made Against You? *

Your Current Insurance Expiry Date *

Professional Body/Association Memberships And Registration Numbers *

Days And Times Preferred For Booking And Additional Information

GDPR Therapist Consent Form

Here at Sage Therapy Centre your privacy is very important to us and we want to communicate with you in a way which has your consent and in line with the UK law. Under the General Data Protection Regulation it aims to provide individuals with better control over their personal data by giving positive consent.

Sage Therapy Centre has in place appropriate technical and organisational measures to protect against unauthorised access or unlawful processing of your data and against accidental loss, destruction or damage to your data and will ensure a level of security appropriate and proportionate to these risks. The processing of your data is necessary for the application to hire therapy room space.

Details of processing activities

The following details the processing as required by Article 28 of GDPR:

Nature and Purpose for which your data will be processed

For Centre administration purposes; to confirm you have the correct qualifications and have the adequate insurance, booking and cancelling rooms, sending room rental invoices and receipts. This forms part of your contract with Sage Therapy Centre and constitutes the lawful basis for processing.

The duration of the processing of your data

Your data will be processed by Sage Therapy Centre whilst you are renting a room and for a period of 12 months after your last room rental
CCTV images are held for 28 days then auto-deleted. CCTV is used for crime prevention and public safety for staff members, contractors and members of the public.

Description of the categories of your data

As detailed on the Sage Therapy Centre Application form.
Insurance Certification
Qualification information
Professional membership/Regulatory Body information
DBS information (only if working with young people)
Room booking history
Invoicing and payment records

Storage of data

We do not hold paper based data and all data will be stored in encrypted Google cloud drives.

Consent

You are consenting to the Sage Therapy Centre in contacting you with the following (Tick all that apply)

(copy) *

To share your contact details with clients, other practitioners, at events, via the website, over the phone, business cards or leaflets.
To share your contact details and photographs (if supplied) on the Centre’s website with the bio supplied by you.
To share your contact details and photographs (if supplied) on social media platforms if we have been asked to do so by you or want to be included in a wider centre event, such as open days.
To keep you informed about centre news, events and activities. You can unsubscribe at any time by clicking the link on the e-mail.

I consent to the Sage Therapy Centre (tick all that apply)

Contacting me by E-mail
Contacting me by Phone

You can find out more about how we use your data from our Privacy Policy which is available on our website, or in the centre.

You can withdraw or change your consent at any time by contacting Sage Therapy Centre Management. Please note that all processing of your personal data will cease once you have withdrawn consent, other than where is required by law and where it is required to fulfil the legal basis of the contract for room rental, but this will not affect any personal data that has already been processed prior to this point

By ticking I give my consent to disclose the attached documentation relating to my application. I understand that further information on how Sage Therapy Centre collects and uses personal information, is available in the Privacy Policy *

(copy) *

By ticking I confirm I accept the Sage Therapy Centre Room Rental Terms and Conditions *

How Did You Hear About Us? *

Print Name *

Date Of Signature *

Signature *

Website

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