Special Stars Foundation - Registration Form

Please note that our funding is restricted to Hull and East Riding of Yorkshire area residents only and therefore we cannot accept applications from anyone outside of this area

Our discounted online shop is available to all UK residents, visit the 'shop' section of our site to browse the full range

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* Details of the person completing this form

Full Name

Address

City/Town

ZIP/Postal Code

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* Please enter your date of birth

DOB

Date

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* What is your gender?

Female

Male

Transgender

Prefer not to say

Other (please specify)

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* Please provide your email address

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* Please provide your telephone number

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* Do you have a disability, health condition, or allergies that you would like us to be aware of?

Yes (please give details here)

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* How would you describe your ethnic group?

White British

White Scottish

White Irish

White Welsh

White Other

White and Black Caribbean

White and Black African

Hispanic or Latino

Asian or Asian American

Polish

Indian

Caribbean

African

Chinese

Arab

Bangladeshi

Mixed Ethnicity

Other (please specify)