solihull.gov.uk

Orange Button scheme registration form for those with existing mental health training

Please complete our Orange Button registration form. This information will be shared with Birmingham City Council's Public Health Team/Solihull Borough Council’s Public Health Team to co-ordinate and register parties to the Orange Button Scheme.

Further information can be obtained by viewing Birmingham City Council and Solihull Council full privacy notice.

* Name:

Organisation

* Email address:

Postal address (where we can send the Orange Button Pack)

* Please tell us what training you’ve had to be able to apply for the Orange Button?

If Other please give details here:

* Which provider delivered this training?

* Date your training took place (PLEASE NOTE this must be within 3 years)

* I understand that the Orange Button is a way that people in the community or workplace can identify me as someone that has received training in suicide prevention. I understand that I am not expected in any way to replace the services provided by mental health teams or emergency services. I will read and follow guidance contained within the Orange Button pack on how to look after my own wellbeing as an Orange Button holder.

* I agree to receive e-mail contact from Public Health Team inviting feedback about the scheme and to keep me updated with Orange Button Community developments and Training Opportunities

Any Comments or feedback?

Data Protection

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk.