1. Register Your Interest in our sessions

Living Well Consortium have been awarded funding through BBC Children in Need to deliver Creative Well-being activities and sporting activities to Children and Young People aged 11 to 18 in the local community.  To register your interest for taking part in the activities please complete this form, one of our session leaders will then contact you to ensure you are given the information needed to access the session.  The information we are asking for is for monitoring purposes only.

The information that we collect will only be shared within our Consortium and The Funder (BBC Children in Need).

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* 1. Young Person's First Name

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* 2. Young Person's Surname

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* 3. Young Person's D.O.B

Date

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* 4. Young Person's Gender (you can self-identify here if you wish to)

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* 5. Young Person: - Tell us a bit about yourself in your own words

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* 7. Young Person: What would you like to achieve in these sessions? What do you find fun and what do you find really boring?

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* 8. Guardian: First Name

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* 9. Guardian: Last Name

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* 10. Guardian:  Address

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* 11. Guardian: Relationship to Young Person

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* 12. Guardian: Contact Number

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* 13. Guardian: Email Address

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* 14. Young Person's GP Surgery (We only collect this date for our monitoring purposes not to contact your GP for any other purpose).

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