Newark ChangeMakers Sign Up Form

Newark ChangeMakers

ChangeMakers is an initiative to give 11-16 year olds a platform to make the changes that they’d like to see in their community.

Register your interest to become a ChangeMaker in our next cohort starting this summer. Please note we will need emergency contact details for a parent or guardian.

ChangeMaker Details

Name:(Required)

Confirm age between 11 - 16(Required)

Yes

Post Code(Required)

Requirements

Allergies, Dietary requirements (For food and drink provided during ChangeMakers), medical or health conditions

Parent / Carer 1

Name:(Required)

Relationship / Known to child(Required)

Email - Parent / Carer 1(Required)

Mobile Number - Parent / Carer 1(Required)

Parent / Carer 2

Name:(Required)

Relationship / Known to child(Required)

Email - Parent / Carer 2(Required)

Mobile Number - Parent / Carer 2(Required)

Main Contact

Main contact for the ChangeMaker(Required)

We will use this to send information about the programme

Name:(Required)

Relationship / Known to child(Required)

Email Confirmation - Main Contact(Required)

Mobile Number - Main Contact(Required)

Any other details

Main Contact Marketing Consent

Yes please I’d like to see YMCA news and offers via email. Select this box to receive email marketing updates. I understand that I can update my preferences or unsubscribe anytime, in line with YMCA RHG policy and UK GDPR standards. Rest assured we will not share your contact details with any other organisations.