Kairos Girls Hub Registration 💕
Complete this short form so we can get to know you and support you during the programme.
Young Person Details
First name
*
Surname
*
Date of birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
*
School or college
*
Home postcode
*
UK mobile number
Young person’s email address
example@example.com
Parent / Carer Details
Parent / Carer Full Name
*
First Name
Last Name
Relationship to Young Person
*
Please Select
Parent
Carer
Guardian
Other
UK mobile number
*
Parent / Carer Email Address
*
example@example.com
Emergency Contact
Emergency Contact Full Name
*
First Name
Last Name
Relationship to Young Person
*
UK mobile number
*
Support Needs and Other Information
Support needs / important information
Allergies
Medical needs
Accessibility requirements
Additional support needs
None
Dietary requirements
None
Vegetarian
Vegan
Halal
Kosher
Gluten-free
Dairy-free
Nut-free
Other
How did you hear about Kairos Girls Hub?
Please Select
School
Friend or family
Social media
Community organisation
Website
Event
Other
Is there anything you’d like us to know about you before you join the Hub?
Consent and Privacy
Privacy notice
Participation consent
*
Yes
No
Photography and video consent
Yes
No
I have read and understand the privacy notice
*
I have read and understand the privacy notice
Register Interest
Should be Empty: