Ready to become a life saver?

Complete this registration form to express your interest in joining our free 12-week Young Life Savers programme. All sessions are delivered on a Friday 6pm till 7.30pm (Community 4 Trust 6.15pm till 7.45pm.

We will use the information provided to contact you about your application and programme arrangements.

Due to limited spaces on each course filling out this application does not guarantee a place.

Please await an E-mail confirmation to confirm your application has been successful.

Fields marked with * are required.

1. Student details

First name *

Last name *

Date of birth *

Age

Calculated from date of birth.

Student email (if applicable)

Student contact number (if applicable)

School or college *

Cohort Selection *

Home postcode (optional)

Address

2. Parent or guardian details

Complete this section if you are under 18, or where parent/guardian contact is required by the organiser.

Parent/guardian full name

Relationship to student

Parent/guardian phone

Parent/guardian email

Arrive/Collection from venue?

3. Emergency contact

Full name *

Relationship *

Contact number *

4. Programme information

How did you hear about us? School or college Friend or family Social media Community organisation Other

Why would you like to join the programme?

Support or accessibility arrangements (optional)

Please avoid including unnecessary medical or sensitive details.

5. Consent and declarations

Please read each statement carefully before submitting. Parent/guardian consent may be required for under-18s.

I confirm that the information provided is accurate to the best of my knowledge. * I have read the programme's privacy notice explaining how registration information will be used. * I agree to be contacted about this application and the arrangements for the programme. * If I am the parent/guardian completing this form, I confirm that I consent to the student's participation in the programme, subject to the organiser's requirements. I give consent for my photo and videos to be used by Hearts in the Stand CIC.

The photography option above is permission to publish images. If you do not wish your images or videos to be used do not check the media box.