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Course Registration Form

Peripheral IV Cannulation — Professional Course

Please complete all sections of this form in full and sign where indicated.

1. Course Details
Course TitlePeripheral IV Cannulation — Professional Course
Duration1 day (7 hours) | Face-to-face, classroom and practical
AccreditationCPD Accredited — 7 CPD Credits
2. Personal Details
3. Emergency Contact Details
4. Professional Details
5. Course Prerequisites

This course requires prior phlebotomy/venepuncture competency and a functional level of English. Please confirm the following:

I hold a Phlebotomy Competency Certificate (copy enclosed with this form)
I have a functional level of English (spoken and written)
I have the right to study in the UK
6. Additional Support Needs

We are committed to making reasonable adjustments so that all learners can participate fully. Any information you share will be treated in confidence, in line with our Accessibility & Additional Support Needs Policy.

Do you consider yourself to have a learning difficulty, disability or health condition?
Do you require any additional support or adjustments to access this training?
7. Registration Documents Checklist

Please submit the following with your completed form. An invoice will be issued once all documents have been received; your place is confirmed upon receipt of payment.

8. Privacy Notice

In order to process your registration, we need to store and process your personal data. Your information will only be used to administer your booking and deliver your training, and will not be shared with third parties without your consent, except where required by law. For more information, please review our Privacy Policy at openacademylondon.co.uk.

9. Learner Declaration

I confirm that the information provided in this form is accurate and complete. I understand that this course involves practical cannulation training on a manikin arm, and that the CPD certificate is awarded only upon successful completion of both the theory and practical assessments. I agree to notify Open Academy London promptly of any changes to the information provided.

Fields marked * are required. Your data is submitted securely to Open Academy London for the purpose of processing this registration.