1.Add your details

Name of adult attending

Last name

Phone Number

Information about the young person

Name of Young Person)

Enter Code provided to book your place

Street Address

City

State

Country

Postal Code

Who is their GP and Surgery details

Relevant physical medical history - conditions, disabilities ect

Mental Health History - Diagnoses, Medications, Self-diagnoses (anything that will help us understand how we can help you better)

Does the person(s) with parental responsibility consent to the YP attending

yes

Are they subject to a care order?

yes

Are you under the care of a CAMHS?

Tell us about any other professionals you see (we wont contact them, just for our information)

What school do they attend?

Is the YP consenting to attending this programme

yes

Do you consent to information about your attendance being shared with your GP practice?

yes

What do they struggle with the most? How would you like us to help them?

Any additional relevant information it would help us to know?

2.Event Policies

19 Nov 2025, 18:30 – 21:00Belfast