Youth Zone - Caudwell Children

You can put as much or as little time into being a CAN member, so it fits in with all your other activities. Remember your involvement will change the lives of other young disabled people.

Young ambassadors, create and display their own profiles, make documentaries and short films, write reviews and blogs and even design new areas of the website.

The Application:

Please let us know as many details as possible, so we can best assess your application.


First Name
Surname
Date of Birth
Address
Postcode
Home Telephone
Mobile Phone
E-mail Address

Do you have access to a computer?
	Yes		No

Parent/Guardian Information (if you are under 18)
First Name
Surname
Address
Postcode
Home Telephone
Mobile Phone
E-mail Address

All About You

Please tell us why you want to be a child ambassador...

What do you like doing?

What activities would you like to do as an ambassador?

Who would you like to meet?

Where in Britain would you like to visit?

What skills will you bring to CAN?

Do you have a disability?

Yes

If Yes, Please tell us about your condition...

How have you benefited from Caudwell Children?

Equipment

Treatment

Therapy

Destination Dreams

What difference has this made to your life?


Media & Publicity
	I am happy for Caudwell Children to use my story to raise the profile of the charity and disability
	I am happy for Caudwell Children to use my photograph for publicity purposes.
	I am happy for Caudwell Children to approach me about interviews and talks.

Ethnicity Monitoring

Please tell us your ethnic origin (Please tick one box only)

	White British	Irish	European	Other
Black / Black British:		Caribbean	African	Other
Asian / British Asian:		Indian	Pakistani	Other
		Bangladeshi
Chinese / Other		Chinese	Other


I agree:
	I want to become a Caudwell Children Ambassador and by ticking this box I have agreed to be involved in the activities and events, including publicity materials.
	I have permission from my parent / guardian.