Membership | Spotlight

You can also download a PDF of the membership form HERE.

Young Person's Membership Form

To be filled in by young person.

Please tell us a bit about you.

First Name *

Middle Name

Last Name *

Phone Number *

Please type in the format 07888888888 or 02030111333.

Date of Birth *

Date of Birth - Day

Date of Birth - Month

Date of Birth - Year

Email Address

Address *

Postcode *

Where did you hear about Spotlight?

Other

Gender *

Male

Female

Prefer not to say

Other

Other Gender *

What are your interests? *

Other Interests *

Are you in education or training? *

Which school/college/university do you go to? *

Please provide details *

Do you consider yourself to have a disability? *

Yes

No

What kind of disability? *

Sensory impairment (such as being blind/having a visual impairment or being deaf/having a hearing impairment)

Physical impairment (such as using a wheelchair to get around and/or difficulty using your arms)

Learning disability (such as dyslexia or Downs syndrome) or cognitive impairment (such as autism or head-injury)

Mental health condition (such as depression or schizophrenia)

Long standing illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)

Prefer not to say

Other

Other Disability *

Please write down any special arrangements or support you need to help you take part in activities with Spotlight. Please also talk to a Spotlight member of staff about this so we can chat more about how we can help:

What is your ethnic group? *

Other ethnic group *

Youth Worker - First name

Youth Worker - Surname

Parent/guardian details

First Name of Parent/Guardian *

Last Name of Parent/Guardian *

Parent/Guardian Phone Number *

Consent

I give permission for Spotlight to collect and securely store and use information, photos and film footage of me and use it to promote Spotlight and its partners work *

I give permission for Spotlight to collect and securely store and use information, photos and film footage of me and use it to promote Spotlight and its partners work

I understand that information may be shared with partner organisations to support me and the services I access *

I understand that information may be shared with partner organisations to support me and the services I access

I agree to Spotlight communicating with me by email, phone, text and post

I confirm that all the information provided in my membership form is true and correct *

I confirm that all the information provided in my membership form is true and correct

If you do not want photos or videos of you to be shared on social media, website or on materials to promote Spotlight please email hello@wearespotlight.com

Full Name *

Signature *

Clear

Privacy Notice *

I agree to the Spotlight Privacy Notice