Young Champions Sign-Up Form Apply to become a Young Champion. The Young Champions programme aims to develop a cohort of young people who can act as leaders on health promotion especially with health issues that impact them amongst their peers. The Young Champions will empower residents of Lewisham with current health information and current government guidance so that family, friends and community members and able to understand, stay safe and make informed choices. Young Champions can be anyone in the community between the ages of 13 – 25 within the Lewisham borough. It is a chance for young residents and those who are underrepresented to have their say in what they feel isn’t working in the community. Young Champions will allow young residents to be involve with the design and development of the Young Champions. Discover, Contribute, Share What is your first name? What is your surname? How old are you? (Please note that if you are under the age of 13 you are unable to sign up to this programme) 13-15 16-17 18-20 21-23 24-25 Over 25 What is your gender? Male Female Other If Other, please specify What is your email address? Where in Lewisham do you live? Bellingham Blackheath Brockley Catford Crofton Downham Evelyn (Deptford) Forest Hill Grove Park Ladywell Lee Green Lewisham Central New Cross Perry Vale Rushey Green Sydenham Telegraph Hill Whitefoot What is you ethnicity? White - British White - Irish White Gypsy or Irish Traveller White - Other Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Mixed - Other Asian - British Asian - Indian Asian - Pakistan Asian - Bangladeshi Asian - Chinese Asian - Other Black - British Black - African Black - Caribbean Black - Other Other Prefer not to say Please tell us why you want to join the Young Champions What health and wellbeing topics are you interested in? Data protection Your personal data will be confidential and used only to contact you about being a Young Champion. The information you provide will be protected by the Data Protection Act 2018. This ensures that we protect the confidentiality of data collected from individuals. We will only use the personal information you provide to deliver the services you have requested, or for our lawful, disclosed purposes. We will not make your personal details available outside our organisation without your consent, unless obliged by law. Terms and Condition: https://lewisham.gov.uk/about-this-site/terms-and-conditions For more information on data protection see our privacy statement: https://lewisham.gov.uk/about-this-site/privacy/main-privacy-statement By checking this box you confirm you have read and agreed to our Terms and Conditions, and that you have read our privacy statement. By ticking this box you confirm you would like to receive more information about the Young Champions