BECOMING Registration Form

BECOMING Registration Form

Register for the BECOMING programme and provide parent/carer, young person, faith, wellbeing, safeguarding, consent, contact permission, attendance, and declaration details.
Parent/Carer Details
Parent/Carer Full Name

First NameMiddle NameLast Name
Relationship to Young Person
If Other, please specify
Email Address
example@example.com
Mobile Number
Please enter a valid phone number.Format: (+44) 0000000000.
Alternative Contact Number
Please enter a valid phone number.Format: (+44) 0000000000.
Preferred Method of Communication
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Postcode
Young Person’s Details
Young Person’s Full Name

First NameMiddle NameLast Name
Preferred Name for Young Person
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age
Current School
Year Group
If Other, please specify Year Group
Young Person’s Email Address
example@example.com
Young Person’s Mobile Number
Please enter a valid phone number.Format: (+44) 0000000000.
About BECOMING & Hopes for the Programme
What would you most like your daughter to gain from BECOMING?
What would your daughter say she would most like to gain from the programme?
Areas where she would benefit from support, encouragement or mentoring

Other
Anything else you would like us to know about her that would help us support her well
Faith & Spiritual Development
How would you describe your daughter’s current faith journey?
If other, please specify
What would you most like her to develop spiritually through BECOMING?
Are there any questions about faith, Christianity or discipleship that she is currently exploring?
Additional Needs, Wellbeing & Safeguarding
Is there anything we should be aware of that may affect your daughter's participation in the programme?
Does your daughter have any additional needs, learning needs or accessibility requirements that we should be aware of?
If yes, please provide details
Is there anything that may make your daughter feel particularly uncomfortable, anxious or unsafe in a group mentoring environment?
Are there any topics or circumstances that you would particularly like us to approach sensitively?
Emergency & Medical Information
Emergency Contact Full Name

First NameLast Name
Relationship to Young Person (Emergency Contact)
Emergency Contact Number
Please enter a valid phone number.Format: (+44) 0000000000.
Alternative Emergency Contact Name
Alternative Emergency Contact Number
Please enter a valid phone number.Format: (+44) 0000000000.
Does your daughter have any medical condition, allergy or other health-related consideration that we need to know about?
If yes, please provide relevant medical details
Are there any emergency procedures or actions that our team should be aware of?
Parent/Carer Consent
Permission for my young person to participate in the BECOMING programme
I understand that BECOMING is a Christian mentoring and discipleship programme and that sessions may include biblical teaching, prayer, discussion and faith-based activities
I understand that The Refinery Collective has safeguarding procedures in place
I understand that information may be shared with the appropriate safeguarding lead or relevant authorities where there is a genuine safeguarding concern or legal obligation
I understand that participation in BECOMING does not replace professional medical, psychological or therapeutic support where such support is required
Contact Permissions
BECOMING programme updates
Programme sessions and activities
Parent information and engagement opportunities
Daughter’s participation where appropriate
Future events and opportunities from The Refinery Collective
Preferred communication method for ongoing contact
Attendance & Commitment
Parent/Carer Agreement. I understand that my daughter is expected to:
Are you able to support your daughter in attending the programme consistently?
Is there anything that may affect your daughter's ability to attend regularly?
Monthly Masterclass Scheduling.

Which days would work best for your family?

To help us determine the most suitable day for the cohort, please rank the days below in order of preference, with your most preferred day at the top and your least preferred day at the bottom.
The final day and time for the monthly BECOMING Masterclass will be determined by considering the overall preferences of participating families, alongside the availability of the BECOMING founders and mentors and the practical requirements of the programme. While we will endeavour to accommodate the preferences of the majority, your preferred day cannot be guaranteed.
Declaration
Parent/Carer Declaration
Parent/Carer Name (for declaration)

First NameMiddle NameLast Name
Date of Declaration

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

BECOMING Registration Form

Parent/Carer Details

Young Person’s Details

About BECOMING & Hopes for the Programme

Faith & Spiritual Development

Additional Needs, Wellbeing & Safeguarding

Emergency & Medical Information

Parent/Carer Consent

Contact Permissions

Attendance & Commitment

Declaration