Young Dynamo's registration form

Name*

Full name

How would you like us to address you?*

Address*

Street Address

City

ZIP / Postal Code

Telephone number*

Email address*

To reduce costs, it would be helpful if we could by email. Please leave blank if you do not wish to be contacted by email.

DOB*

Name of school/college or university you attend*

Does your parent or carer know you want to join young dynamos?*

Emergency contact details*

Do you have of the following: physical disabilities, mental health issues, learning difficulties?*

To help us support you during the sessions, please state below what they are and how we can best support or help you.

Do you have any additional needs that we need to be aware of?*

If yes, please give details

Do you have any allergies or dietary requirements? (We often have food and refreshments at meetings)*

If yes, please give details

Is there anything you would like to let us know?

Young Dynamo’s registration form