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* 1. Please enter your own details

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* 2. Please enter details of an alternative emergency contact

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* 3. To join the programme your child must be between 10 - 15 as 31st December 2018. Please confirm - how old will your child be on 31st December 2018

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* 4. Will you be joining our Parents Programme? It's a discussion forum to share knowledge and experiences about upbringing of our children. (It is held on the same day at the same time in the same venue)

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* 5. Please TICK to confirm that you give us permission to use images/video/quotes of your Diamond and yourself for promotional/marketing purposes. We share images/video on our website, social media, enewsletter etc (but we do not disclose any private or confidential information)

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* 6. Are there any facts/issues we should be aware of whilst mentoring your child?

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* 7. Our programme is free to everyone, but we rely on donations from our community to fund our work. Would you be willing to make a standing order donation to help us continue to deliver for our community?

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* 8. How did you actually find out about our Community Mentoring Programme?

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* 9.

Please enter the details of up to 2 children you would like to register on to the mentoring programme.

 

Child 1

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* 10.

Child 2

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