Young People Sign Up Form

This form is for young people aged 8-25 signing up to our online programmes. Our data promise: We’ll never sell or swap your details with anybody else. We only hold your details for as long as necessary and you can withdraw your consent at any time by letting us know. For more information about how use and protect your data our privacy statement can be found in the banner at the bottom of this page.

Project Area (required)

Name of staff member you will be working with or project name (if you know it)

Contact Details

Full Name (required)

Address (with postcode) (required)

Phone Number (required)

Email (required)

Date of Birth (required)

Gender (required)

Ethnicity (required)

Parents Phone Number or email address (required)

Publication Consent

Headliners uses the content produced by young people to raise the voice of young people in society.

We take special care to ensure that young people are never over identified, are consulted about the content they create and publish and are credited for their own work.

BY TICKING THE BOX BELOW I GIVE MY PERMISSION to Headliners to film and record my contribution, and to use the material produced for publication or broadcast across the web, television, radio and/or any other media outlet. This means that Headliners has the right to publish my articles and any other work without asking for my permission again.

Please tick if you give Headliners consent to publish (required)

Media content you have createdPhotos/ film content that you are visible in