Young Person's Consent (over 13 only)
PLEASE READ:
We treat your data very carefully and respectfully, we do not share it with anyone unless legally obligated. Please complete the following questions to help us understand more about the young people we work with and to ensure we can meet any needs you have, Thanks
Are you 13 or over? *
This form is to be used by young people over 13 only - if you are under 13 please speak to a youth worker
First Name *
Your answer
Second Name *
Your answer
Preferred Name (if different)
Your answer
Address Line 1
Your answer
Town/city
Your answer
County
Your answer
Post Code
Your answer
Email address (Leave blank if you do not have one)
Your answer
Home phone number (Leave blank if you do not have one)
Your answer
Mobile number (Leave blank if you do not have one)
Your answer
Ethnicity
It's important to us that we understand how diverse our membership is so we can ensure everyone is getting a chance to take part
Date of Birth *
We need to check our age ranges meet our priority of 11-19 year olds - To add the Date of Birth you can either type the date in or use the arrow - if using the arrows you need to select the year and find the month then click on the day.
MM
/
DD
/
YYYY
Gender
Disability
It's important to us that we understand how diverse our membership is so we can ensure everyone is getting a chance to take part
If you do have a disability, tell us how we can help you
Your answer
Medical information or allergies
Please give us any information to help you stay safe, including if you carry medicine that we should know about.
Your answer
Which Youth Centre do you attend? *
Protected Characteristics
It's important to us that we understand how diverse our membership is so we can ensure everyone is getting a chance to take part
Social Care Status
It's important to us that we understand how diverse our membership is so we can ensure everyone is getting a chance to take part
Religion
It's important to us that we understand how diverse our membership is so we can ensure everyone is getting a chance to take part
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