Details about you 

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* 1. Your name:

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* 2. Your date of birth (if under 18):

Date

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* 3. Your address:

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* 4. Your postcode:

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* 5. Your telephone number:

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* 6. Your mobile number:

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* 7. Your email address:

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* 8. Your emergency contact name:

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* 9. Your emergency contact number:

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* 10. Do you have specific support needs? If yes, please specify: 

These next two questions are to gather statistics for our project funding partners, please answer if you are comfortable:

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* 11. What is your age?

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* 12. What is your gender?

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