Participant Registration

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Name *

First

Last

Date of Birth

Age

Email *

Phone Number

Current status: (tick all that apply)

First Choice
In education
Employed
Unemployed
Self-employed
Not currently in education, employment, or training

Tell us briefly why you want to join this program (max 150 words):

What are your main goals for the next 6–12 months?

Do you have any accessibility or support needs we should be aware of?

Please specify

Do you have access to a device and internet to attend online sessions?

Yes
No
Sometimes

Do you give permission to be photographed or recorded for program marketing purposes?

Data Protection & Consent
We take your privacy seriously. The personal information collected in this form will be used solely for the purpose of delivering and evaluating the Youth Development Program. Your data will be stored securely and will not be shared with third parties without your consent, except where required by law.

Please tick the boxes below to confirm your understanding and consent:

I understand that my personal information will be stored securely and used only in connection with the Youth Development

Program

I give consent for my data to be used for program communications, scheduling, and monitoring purposes.
I understand that I can withdraw my consent at any time by contacting the program coordinator.

How can we support through a mentoring program

Arising Youth program is dedicated to motivating and empowering young individuals

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We value your input and are committed to providing swift and courteous responses to ensure your needs are met. Feel free to reach out, and we look forward to connecting with you.

Address 38 -78 cromwell street CV6 5EZ
+ 07462601740

[email protected]