Freedom Leisure Youth Membership Application

The programme supports young people with the finances of a membership where this is currently a barrier to getting active. Please complete the follow questions in order to register your interest. This information will be stored securely under our GDPR policy.

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* 1. Name of young person registering (parent email if under 16):

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* 2. Date of Birth:

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* 3. Emergency contact name:

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* 4. Emergency contact number:

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* 5. Please list any medical conditions we should be aware of:

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* 6. Do you have a disability or any access requirements:

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* 7. Please select your physical activity levels in a week (outside of PE):

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* 8. Please say why you are applying for this funding support (how might this benefit you):

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* 9. Which is your preferred leisure centre:

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* 10. Referrer details (parent/guardian/youth service)

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