S.H.E Leads
LEADERSHIP PROGRAMME FOR YOUNG WOMEN 
Email address *
I'm applying for: *
First Name of Participant *
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Surname of Participant *
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Date of Birth *
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Home Phone number *
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Participant's Mobile number (if applicable)
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Participant's email (if applicable)
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Address *
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School *
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Parent/Guardian Name *
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Parent/Guardian Mobile number *
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Parent/Guardian email *
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I am in Year (2018): *
Who referred you to Leadership Programme/how did you hear about us? *
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Would you like to receive information on activities for mothers? *
Mentoring *
Mentoring is an important part of the Leadership programme, therefore, we would be grateful to hear from you about days and times that facilitate mentoring sessions with your daughter on a monthly basis.
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Does your daughter suffer from any allergies/medical condition? *
If yes, please specify allergy/ details of condition and treatment *
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Media consent. I agree/do not agree* to allow Fernhall to use my daughter’s images, photographs, videos for Fernhall's promotions and advertisements. * *
Any other comments:
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