YOUTH VOICE PROJECT

Palm Beach Youth Voice Project – Application Form

CHILD DETAILS

First name

Last name

Email

Phone

Preferred contact method

Email

Phone

Other

Age

11

12

13

14

15

16

Post Code

Which area do they live in?

Wellingborough

Kettering

Corby

Rushden

Irthlingborough

Thrapston

Oundle

Raunds

Higham Ferrers

Burton Latimer

Desborough

Rothwell

Other

Education

School

College

Home educated

Emergency Contact

Name

Phone

Relationship to you

How would you describe your ethnic background?

Asian / Asian British

Black / African / Caribbean / Black British

Mixed / multiple ethnic backgrounds

White

Other ethnic background

Prefer not to say

Other

Do you have a disability, long-term health condition or additional need?

Yes

No

Prefer not to say

PERMISSION

I have permission from my parent/carer to attend Palm Beach Youth Voice Project meetings and take part in the project.

Answer the Call – Palm Beach Youth Voice Project Application Form