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Act On It contact and consent form
I
n completing this form, I give my consent for my child to take part in Act On It online sessions.
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Email
*
Your email
Parent /carer name
*
Your answer
Particpant's name
*
Your answer
Participant's age and date of birth
*
Your answer
Parent / carer phone number
*
Your answer
Home address and Postcode
*
Free places on this project are available for residents of Eastbourne and South Wealden. By providing your address, we can check eligibility.
Your answer
Supporting Information
(any other information you would like to share with us)
Your answer
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