City & Hackney Condom Distribution Scheme

Good job on making the decision to look after your sexual health and get free condoms and lube. 

To become a part of the scheme, simply fill out the registration form below. Rest assured that once your data has been processed, it will be securely deleted from this form, ensuring your privacy and confidentiality.

Find out more about the Condom Distribution Scheme: https://www.younghackney.org/advice/health/free-condoms/

You can view our privacy statement here for more information about how your data is collected and handled: https://hackney.gov.uk/cfs-privacy
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You do not need to use your legal name to register. Just enter a name and surname you will use to identify yourself.
First name *
Surname *
Your date of birth *
You must be under 25 to use this service.
dd/mm/yyyy
Gender *
Required
Is your gender the same as the one you were assigned at birth? *
Required
Borough you live, work or study in.  *
If you do not live, work or study  in Hackney or the City of London, you will be unable to register.
Required
Full postcode of your residence, workplace or place of education.  *
This must be a Hackney or City of London postcode, e.g. E8 1EA
Understanding the needs of different groups can help us to provide better and more appropriate services. We want everyone, no matter what their ethnic group, religion or culture, to be able to use our services easily.

The demographic data you provide below is just for our own stats and insights. Your responses to this are totally anonymous and not linked to you.
Sexual orientation *
Required
Ethnicity *
If you would prefer not to share your ethnicity data, please select the "Prefer not to say" option.

This is the last question - you will be registered for the Scheme within one working day after completing this.
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