Young People (12-17) Online Support Group

Hello, before we can sign you up to our forthcoming support group, we just need to capture a little information on the form below. Don't worry, this will only take two minutes and the data will only be used so that we can ensure participants well-being.

Meeting Date: Wednesday 4th December, 6pm

Step 1 of 4

Before you can register for this support group, we need to get a little more information from you.
Participant Name
The person taking part in the support group?
First Last
Participant Date of Birth*
The participant needs to be aged 12-17 to attend this meeting. Please confirm the participants date of birth
DD slash MM slash YYYY
Participant Email Address*