R-CITY Member Application (Request)

Programme Details:
Programme:
Programme Applied For:
Programme Code:
Your R-CITY Facilitator will tell you which tracking code to use.
Member Details:

Tell us all about your
Member Name:

First NameLast Name
Member Home Address:

Street Address

Street Address Line 2

CityState / Province

Post Code
Member Mobile No:
If you don't have one, enter your Parent/GuardiansFormat: 00000 000000.
Do you have an Email address?
Your Email Address:
example@rgstr.co.uk
Member Date of Birth:

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Member Age:
Member Religion:
Parent/Guardian Details

Please ensure you give us correct, up to date details.
We must contact your Parent/Guardian to proceed with your membership application. This will be done using their email address. We will contact them with part 2 of the application and consent process.

Your application is not complete until we receive their consent. Please ask your Parent/Guardian to check their email after submitting this form.
Parent/Guardian Name:

First NameLast Name
Relationship to You:
Parent/Guardian Email Address:

Confirmation Emailexample@example.com
Heads up! 🚨
When you send this form, your Parent/Guardian will get an email asking them to give their consent.

👉 Your application isn’t finished until they do this.
👉 You won’t be a member of RCITY until their consent is submitted.
👉 Ask your Parent/Guardian to check their inbox (and junk/spam folder) in case the email ends up there.

The email should arrive in the next few minutes!

Programme Details:

Member Details:

Parent/Guardian Details

Young Person Declaration