Welcome to Bolster Community on-line Programme registration. Please complete the registration below accurately and in full. Failure to do so may delay your successful registration

SECTION 1: Please provide information below for the person registering for the programme

First Name*

Surname*

Date of Birth*

Gender

Name of school

(Note: if registration is for a programme through school, name of school is required)

Home address line 1*

Address line 2

County*

Town

Postcode*

Main Telephone No.*

Mobile Telephone No.

Primary Email Address*

SECTION 2: Please provide contact information for guardian and/or emergency contact

Emergency Contact*

Emergency contact relationship

Emergency telephone contact number*

Emergency contact email

Do you give consent for photos/videos to be taken and used on social media?

Consent Given*

SECTION 3: Personal Details

Main Disability*

Allergens*

Dietary requirement*

Religious Group

Ethnic Group

SECTION 4: Relevant Information

Please specify programme that you are interested in attending?

Any other relevant information?

Confirmation

Terms & Conditions and Privacy Policy

Under the General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679) The information contained in this registration form may be used by Bolster Community for research purposes, and participants may be contacted by Bolster Community in relation to their participation in the Bolster Community programmes. We will take all steps necessary to ensure that your personal details are securely held/archived and destroyed. You have the right to request a copy of the information that Bolster Community holds on you. To do so, either you or an authorised third party must request this in writing to: Operations Manager, Bolster Community, 1 Whitegates, Newry BT35 6UA

I accept the terms and conditions*