Summer Camp Application

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Please fill in this form to apply for a place at LGBT+ Young Persons' Summer Camp.
Please respond fully or you will be required to re-submit the whole form.
Allocation of the places is going to be decided by the team and is final.

Do you have a guardian consent if you are under 18? *

I am over 18

I am 18

I am under 18 and I do have a consent (you can only apply if your legal parents have given you permission to do so)

I am in care (we can help you get the consent)

Required

What is the participant's gender pronoun? *

He / Him / His

She / Her / Hers

They / Them / Theirs

Other:

Participant’s legal first name *

Participant’s legal last name *

Participant’s preferred name, if other than above

Participant’s gender identity *

What is the Particpant’s date of birth? *

YYYY

Participants full address including post code *

Participant’s phone number

Participant’s email address

What is the Participant’s t-shirt size? *

What religious/spiritual practices do we need to accommodate? (e.g. fasting, prayer etc.) *

Which ethnicity do you primarily identify with? *

We collect this information as we need to make sure that we are inclusive. Ethnicity can be White British or Black African or Mixed for instance.

White British

White Irish

White Gypsy or Irish Traveller

Not listed White background

White and Black Caribbean

White and Black African

White and Asian

Not listed mixed background

Indian

Pakistani

Bangladeshi

Chinese

Not listed Asian background

Black African

Black Caribbean

Not listed Black background

Arab

Unlisted

Prefer not to say

If you have a disability please tell us about it and advise us on how we can make your Camp experience accessible

If you have a mental health concerns please advise us on what it is and how it demonstrates itself so that we can make sure you are safe and well while in our care *

If you have any dietary requirements please let us know below (e.g. vegan)

If you are on any medication please list below including dosage and frequency

If you have any allergies please list them below

Are you able to cycle unaided? *

Are you able to swim unaided? *

Emergency contact details full name, address and phone number (this must be your legal guardian if you are under 18): *

Secondary emergency contact details full name, address and phone number (this must be an adult that's close to you) *

What makes you want to come to the LGBT+ Summer Camp?

Summer Camp is where all participants are co-creators of the space hence summer camp is only as good as participants make it. Do you agree to be an active, inclusive and respectful participant of all activities on offer, and part-take in any chores that you will be allocated?

Yes

Clear selection

If there is anything else we need to know to make sure you feel inclded and respected, please provide details here:

The cost of the Camp is £377 per person and is inclusive of everything. How much of that cost can you afford? *

How are you going to pay: *

I will pay in full in advance

I will pay in interest free instalments (we will send you details after registration is complete)

I would like to apply for partial or full financing to help me access the retreat (please fill in the next question)

If you are applying for partial or full funding towards the Retreat, tell us more about your situation so that we understand your financial circumstances:

By filling in this form, I consent to my data being stored and processed to facilitate my access to Mosaic LGBT+ Young Persons' Summer Camp: *

Yes

No (this application will be deleted)

I would like to be added to Mosaic mailing list for news on events and other LGBT+ programmes that Mosaic LGBT+ Young Persons' Trust runs: *

Yes

Submit

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