CMP Registration 2017/18 Question Title * 1. Please enter your own details Your First Name * Your Surname Home Address * Your Email Address: * Your Mobile Number * Question Title * 2. Please enter details of an alternative emergency contact Alternative emergency contact person Alternative emergency contact's address (optional) Alternative emergency contact's email (optional) Alternative emergency contact's phone number Question Title * 3. Your Child's Details Your Child's First Name Your Child's Surname Your Child's School Question Title * 4. Your child's gender Female Male Question Title * 5. How old will your child be on 31st December 2017 10 11 12 13 14 15 Question Title * 6. Will you be joining our Parents Programme? It's a discussion forum to share knowledge and experiences about upbringing of our children. (It is held on the same day at the same time in the same venue) Yes No Question Title * 7. Please TICK to confirm that you give us permission to use images/video/quotes of your Diamond and yourself for promotional/marketing purposes. We share images/video on our website, social media, enewsletter etc (but we do not disclose any private or confidential information) Yes, I give you permission No, I don't give you permission Question Title * 8. Are there any facts/issues we should be aware of whilst mentoring your child? None Dietary Behavioural Emotional Other Please tell us specifics of what we need to know Question Title * 9. Are you interested in becoming a volunteer for the 100 Black Men of London? Yes No Question Title * 10. How did you actually find out about our Community Mentoring Programme? Word of Mouth Our eNewsletter Our Website Facebook Twitter Linkedin Flyer Another Organisation Newspaper Radio Google Search Other (please specify) Done