Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

Country

(###)

###

####

Can we add you to our coaches/volunteers WhatsApp? *

This group is a professional group moderated by safeguarding officers. Its a place where we share information on plans and sessions.

Yes

No

Please indicate your time commitment. *

volunteers are not obligated to attend, however we ask you to make a commitment so we can plan to mentor you and put the correct support in place. You can select all times or just one.

Wed at Magee Uni 5.00pm-8.00pm

Fri at Foyle College 4.30pm-7.45pm

Sat at Foyle College 9.15am-2.00pm

Only part of one of the options above

Emergency Contacts *

Please provide details of two emergency contacts in case we need to contact someone on your behalf.

First Name

Last Name

Phone *

Country

(###)

###

####

Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Date *

MM

DD

YYYY