Participant Details

First Name (required)

Last Name (required)

Date of Birth (required)

Gender —Please choose an option—MaleFemaleNon-BinaryPrefer Not To SayOther

Ethnic Origin —Please choose an option—WhiteAfrican/Caribbean/BlackMixed Racial GroupAsianChinese, Chinese Scottish or Chinese BritishPakistani, Pakistani Scottish or Pakistani BritishBangladeshi, Bangladeshi Scottish or Bangladeshi BritishOther (e.g. Arab)Unknown

Email

Street

City

Postcode

Local Authority Area
—Please choose an option—Glasgow CityNorth LanarkshireSouth LanarkshireWest DunbartonshireEast DunbartonshireRenfrewshireEast RenfrewshireInverclyde

Home phone

Mobile phone

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Relationship to Emergency Contact —Please choose an option—ParentSpousePartnerCousinAuntUncleGrandparentGrandchildFamilyOther

Referrer's Details

Referral Type (required)
—Please choose an option—Self-ReferralReferral Organisation

Participant Information

How did you hear about the project?
—Please choose an option—WebsiteSocial MediaFamily/FriendCeltic FC Foundation Open DayReferral AgencySocial WorkerOther

Have you previously attended any projects through Celtic FC Foundation?
—Please choose an option—YesNo

Consent
May we use personal details to inform you of forthcoming events?

Please note that video or still photographs may be taken during the project which may be shared with funding partners and/or used in future marketing materials such as, but not inclusive to Celtic FC Foundation website, Celtic View, Celtic website or Celtic TV. Does the participant agree to this?

Across each workshop we undertake case studies to highlight the journey of the participant. These case studies allow us to gather feedback on the project, particularly what works well and what areas for improvement. Does the participant agree to this?

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