The Change Room - registration form for 13-16 year olds
To be completed by a parent or carer. We'll keep you in touch with full details of the upcoming programme, and will ask for more details including emergency contact information once the young person has signed up for a course.
Parent or carers name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Young person's name
First Name
Last Name
Which elements of The Change Room is the young person interested in?
ReMotivators
ReCycle or Dye
Volunteering
DigiMode
ReVerb
Zine Production
Everything!
How old will the young person be on 1st June 2021?
Any questions or comments?
Submit
Should be Empty:
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