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Easter Programme Activity Form
Easter Youth Programme
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Your Information
Do you consent to your child's photograph being taken and potentially used across promotional material taken at our Easter Programme? Please enter Y/N.
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Your answer
First Name and Surname
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Your answer
Gender
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Female
Male
Other
Date of Birth
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Your answer
Phone Number
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Your answer
Home Address and Postcode
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Your answer
School
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Your answer
Parent/Carer Information
Guardian Full Name
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Your answer
Relation to You
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Your answer
Guardian Contact Details (telephone and e-mail address)
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Your answer
Do you have any special learning needs/disabilities? (if 'Yes', please specify)
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Your answer
Do you have any dietary requirements/allergies? (if 'Yes', please specify). If your child is taking part in Ramadan, please write ‘No meal due to Ramadan’ in the box below.
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Your answer
What is your ethnicity? Please choose one box.
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White: English/Welsh/Scottish/Northern Irish/British
White: Irish
White: Gypsy or Irish Traveller
White: Other
Mixed/Multiple Ethnic Group: White and Caribbean
Mixed/Multiple Ethnic Group: White and African
Mixed/Multiple Ethnic Group: White and Asian
Mixed/Multiple Ethnic Group: Other
Asian/Asian British: Pakistani
Asian/Asian British: Bangladeshi
Asian/Asian British: Chinese
Asian/Asian British: Other
Black/African/Caribbean/Black British: African
Black/African/Caribbean/Black British: Caribbean
Black/African/Caribbean/Black British: Other
Other:
Are you interested in any of the other services offered by the Renewal Programme?
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Training and Education for Adults
Food Bank
Immigration Advice
Community Hub
Telephone Befriending
Digital Inclusion
Youth Club
Volunteering
Fundraising
Free Additional Tuition for Young People aged 11 and 16
Other:
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