A Safe Space for 14-17 year olds

Name of booker *

Email of booker *

Booker's contact phone (preferably mobile) *

Participant's full name (if not the booker) *

Participant's email (if not the booker and prepared to share this information)

Participant's Girlguiding county * Cleveland
Durham North
Durham South
East Yorkshire
Leeds
Lincolnshire North
Newcastle
North Tyneside
Northumberland
North Yorkshire North East
North Yorkshire South
North Yorkshire West
Sheffield
South Yorkshire
West Yorkshire North
West Yorkshire South
West Yorkshire West

Participant's Girlguiding unit *

Participant's Girlguiding Membership Number (if known)

Please supply the email address of the participant's parent (if not the booker) so we can send a consent form to them for completion prior to the training

Does the participant have any accessibility or other requirements of which we should be aware? *

Please give the name and telephone number of an emergency contact who will be available during the training should the trainer need to contact someone during the event, ie, if the participant becomes unwell *

I confirm that I understand this booking is for one participant only. If you wish more than one participant to attend then a separate booking must be done for each.

I consent to my submitted data being collected and stored as outlined by the site .