Youth Group Survey

What EMAIL address can we contact you on? (can be yours or a parents)(Required)

What MOBILE NUMBER can we contact you on? (can be yours or a parents)(Required)

What Postcode do you currently live in?(Required)

What is your DATE OF BIRTH?(Required)

Do you have a preferred day and timeslot from the above options?

Are there any other ideas or activities you would like us to consider for this new Youth Group?

What is your favourite name idea(s) for the new Youth Group in Selby? (maximum of 3)(Required)