LGBT Youth Summer Camp Registration
Please fill in this form to register your interest in Mosaic LGBT Youth Summer Camp
Do you have a guardian consent if you are under 18? *
What is the campers gender pronoun? *
Camper's legal first name *
Your answer
Camper's legal surname *
Your answer
Camper's preferred name if other then above
Your answer
Camper's date of birth
Your answer
Camper's gender identity *
Your answer
Campers full address including post code *
Your answer
Camper's phone number:
Your answer
Camper's email address:
Your answer
What religious practices do we need to accommodate within your stay with us?
Your answer
If you have a disability please tell us about it and advise us on how we can make your camp experience better
Your answer
If you have a dietary requirements please express them below.
Your answer
If you are on any medication please list below including dosage.
Your answer
If you have any allergies please list them below.
Your answer
Are you able to swim? *
Emergency contact details name, address and phone number *
Your answer
Secondary emergency contact details name, address and phone number *
Your answer
What makes you want to come to the LGBT Youth Summer Camp?
Your answer
If there is anything else we need to know please provide details here:
Your answer
The cost of the Summer Camp is £377 per person. *
Tell us more about your situation so that we understand your financial circumstances if you are applying for partial or full campship:
Your answer
By filling in this form I consent to my data being stored and processed to facilitate my access to Mosaic LGBT Youth Summer Camp *
I would like to be added to Mosaic mailing list for news on events and other LGBT programmes that Mosaic LGBT Youth Centre runs *
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