Young Lambeth cooperative
Registration Form

Over the last year Lambeth Council has been working with a wide range of residents, service users and partners to develop a cooperative approach to running services in the following areas: Youth centres, Adventure playgrounds, Stay and Play One O’clock clubs, and Young and Safe (a project for young people who are at risk of serious youth offending).

Our next step is to set up a Young Lambeth cooperative that will oversee some services for children including play and youth. We want young people (aged 11 and over), parents, local residents, groups and organisations to help us do this.

If you want any further information or would like to discuss anything please,
Visit www.lambeth.gov.uk/cooperativecouncil
Call 020 7926 3778 or
Email cooperativecouncil@lambeth.gov.uk

What to do when you have completed this online form
Please click on 'Submit' at the end of this online registration form.

Thank you

1.	Name (first and last name):

2.	Organisation name (If applicable):

3.	Address (Include full post code)

4.	Email:

5.	Day-time telephone number:

Age

11 years

12-16 years

17-19 years

20 years and over

If you are aged between 11-16 years, please can you inform your parent or carer that you have registered your interest in the young Lambeth cooperative.

Upon receipt of your registration, we will write to your parent/carer to inform them of your registration and if you are 11 years old, we will send a parental consent form for completion

I have informed my parent/carer of my registration

I have not informed my parent/carer of my registration

Gender..... Please SELECT ONE OPTION ONLY

Male

Female

To which of these groups do you consider you belong? Please SELECT ONE OPTION ONLY

White (British, Irish, or any Other White background)

Mixed (White and Black Caribbean, White and Black African, White and Asian, or any other mixed background)

Asian or Asian British (Indian, Pakistani, Bangladeshi, or any Other Asian background)

Black or Black British (Caribbean, African or any Other Black background)

Chinese

Prefer not to say

Any Other ethnic group

	If 'other', please tell us:

10.

Please tell us which of the options below best describes you? Please SELECT ALL THAT APPLY

A Lambeth resident

A parent or carer

Work or volunteer in Lambeth

Go to a school in Lambeth

An organisation delivering services in Lambeth

Other

	If 'other', please state:

11.

I am interested and want to get involved in...Please SELECT ALL THAT APPLY

Attending meetings or events

Receiving regular information about Young Lambeth cooperative

Standing for election to the Young Lambeth cooperative Steering Group

Taking part in consultations

What to do next?
Please click on 'Submit' to send you completed form

The information you provide will be used solely for communicating with you about Young Lambeth cooperative. The information will be kept confidential and will not be shared and will be managed in accordance with the data protection guidelines

Thank you for registering your interest in the Young Lambeth cooperative.
We will be in contact with you in the next month.

Young Lambeth cooperative Registration Form

Young Lambeth cooperative
Registration Form