Name of young person

Surname:  *

First Name:  *

Address:  *

Postcode:  *

Age of young person:  *

Date of birth of young person:  *

Sex (male or female):  *

Home telephone number:

Mobile:

Email:  *

Name of responsible adult attending Spotlight Junior with the young person

Name of adult:

How did you find out about Spotlight Juniors?

What is your reason for attending Spotlight Juniors?

If you would like to find out more information about Spotlight Juniors please click here:

If you would like to join Spotlight Juniors mailing list please click here:

Terms and Conditions:

By ticking here: I certify that the information contained on this form is correct and understand that it will be used for monitoring purposes for Rising Tide and Hackney Youth Service .

By ticking here: I certify that I have given permission for any images of myself contained as video footage or still photography to be used for marketing and promotional purposes for Rising Tide and Hackney Youth Service.


THIS EVENT WILL BE FILMED

(Press the submit button if you agree to the terms and conditions outlined above)