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Welcome to our Online Payment Area
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EXTERNAL ACCOUNT CREATION FORM
Please complete all sections of this form to enable you to create an account and make a purchase.
Students Personal Details
Forename:
*
Middle Name(s):
*
Legal Surname:
*
Previous Surname:
*
Preferred Forename:
*
Gender:
*
Please Select...
Male
Female
Date of Birth:
*
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Address:
*
Postcode:
*
Contact Details
Mobile Number:
*
Home Number:
*
Email Address
*
This will be your username and will be required when you log in to Wisepay.
Confirm Email Address
*
Please confirm your email address to ensure it has been entered correctly.
Password
##########
WisePay will automatically generate a strong password when this form is submitted. You will be sent an email to the email address entered above containing your log in credentials.
Emergency Contacts
Please supply details of a contact, should this be required in case of an emergency. This can be next of Kin or Line Manager of where you work.
Surname:
*
First Contact
Forename:
*
First Contact
Daytime Telephone:
*
First contact
Surname:
*
Second Contact
Forename:
*
Second Contact
Daytime Telephone:
*
Second Contact
Medical Information
Is there any health condition/allergies that the Counselling Academy need to be aware of:
Yes
No
If yes to condition/allergies, please state the condition
Do you carry any of the following emergency medications for yourself?
Asthma Inhaler
EpiPen
Insulin for Diabetes
Image Consent
To comply with the GDPR and the Data Protection Act, we need to obtain consent before we can photograph or make any recordings of you or your work. Should we want to do this, we would notify you of the use of any taken images/work, i.e. for publicity material for our courses.
I give my consent for my image to be taken and used in publicity material for the academy, including printed and electronic publications, video and webcam recordings and on websites.
Yes
No
(No full name will be displayed with any work used)
I give consent for my work to be taken and used in publicity material for the academy, including printed and electric publications, video and webcam recordings and on websites.
Yes
No
(No full name will be displayed with any image used)
Online Safety Agreement
ICT including the internet, e-mail, mobile technologies and online resources have become an important part of learning in our school. We expect all students to be safe and responsible when using any ICT. It is essential that students are aware of eSafety and know how to stay safe when using any ICT.
Students are expected to read this agreement and then to sign and follow the terms of the agreement below. You should also agree not to share school related information or images online or to post material that may bring the academy/school or any individual within it into disrepute.
You should also agree only to use personal mobile phones and devices in designated areas of the school unless otherwise informed, e.g. for specific events and activities. Understand that under no circumstance should images be taken at any time on school premises of any children or students on the workshop, unless there is a pre-specified agreement. Understand that when on school premises but not in a designated area where phones can be used, they must be switched on silent.
I will only use school IT equipment for school purposes.
I will not download or install software on school IT equipment.
I will not reveal my passwords to anyone.
I will make sure that all my electronic communications are responsible and sensible.
I understand that everything I search for, access, post or receive online can be traced now and in the future. My activity can be monitored and logged and if necessary shared with teachers and the police if necessary.
I know it is essential that I build a good online reputation.
I will not browse, download, upload or forward material that could be considered offensive or illegal. If I accidentally come across any such material I will report it immediately to a member of staff.
I should never post photographs, videos or livestream without the permission of all parties involved.
I will respect the privacy and ownership of others' work on-line and will adhere to copyright at all times.
I confirm I have read the Online Safety Acceptable Use Agreement and I am ready to create my account.
Yes I accept.
GDPR
Yes
No
Your data provided here will be used solely for the purposes of attendance at this CPD workshop. We will not forward your data onto any 3rd party. We will delete your data from our records within 3 months after the event date. Would you like to receive information about our future events by email?
Year Group:
For Office Use Only
(For Office Use Only)
This challenge is to prevent automated systems from using this feature maliciously.
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Protection of Personal Data and GDPR legislation
ZZZMarriotts School (Terminated 06/11/2021) may ask you to provide personal data on this form. This data is stored by WisePay on behalf of ZZZMarriotts School (Terminated 06/11/2021), to meet the legal obligations of a contract between WisePay and ZZZMarriotts School (Terminated 06/11/2021). You are required to give your consent that this data can be processed by ZZZMarriotts School (Terminated 06/11/2021).
Your Consent
I consent that this data can be processed by ZZZMarriotts School (Terminated 06/11/2021).
Please ensure all consent / agreement fields have been accepted.
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