2022 YCF Young People’s Monthly Epilogue

1) About the participant
Name * Required
First Last
Preferred name * Required
Pronoun
We would like to adopt a culture where the gender pronoun an individual is comfortable with is not assumed. If you are comfortable doing so please let us know the pronoun you use.
Participant's Date of Birth - must be dd/mm/yyyy format * Required
DD slash MM slash YYYY
Participant's age * Required
On 1 September 2020
Participant's email * Required
Participant's mobile phone number * Required

Note: We will only use phone contact details in case of emergency.
Participant's address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Community agreement * Required
Please read the community agreement which is here. You should then indicate your agreement to this and uphold this in how you conduct yourself during the event.
- I agree
Quaker Community
If you or your family are connected to a Local, Area or Yearly Quaker Meeting please add details here.

2) Participant's needs
Support
Is there anything you would like to let us know about that would support your wellbeing or participation in the group?
Any information which you provide will be treated in confidence. However, if we are concerned that you or someone else is at risk of harm, we may need to take action in response to these concerns.

3) Parent or Guardian contact details
This is so that we can ask for their permission for your participation in the online group. Also so we can be in touch in case of concern about a young person.
Name * Required
First Last
Relationship to you * Required
e.g. mother, father, guardian etc
Parent or Guardian's Email * Required
Please provide an email address that they use regularly so that we can contact them.
Parent or Guardian's contact telephone number: * Required

Note: we will only use phone contact details in case of emergency.

Participant's Doctor's surgery. Name, address and contact telephone number. * Required
Note: We will not normally contact the GP and will only do so if we assess the young person as being at serious risk of harm to themselves. If this is the case then we should explain this to the young person and their parent/guardians, unless doing so would put the young person at further risk. If they are sharing information they should tell you how they will be recording this concern, who they will inform and what will happen next.

QForms