Brighter Youth Registration Form

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Welcome to Brighter Youth Talking Therapies.

Use this form to register for support - this form is for children and young people living in Wrexham from their 8th to their 19th birthday (or 25th birthday if additional learning needs are identified)

You can use this form to register for support for yourself, your child, or a young person you are working with. To check this is a suitable service, please read our information page here. After we receive your form, we'll review the information provided. If Brighter Youth looks like it may be suitable, we'll contact you about arranging a Welcome Chat. This is an opportunity to talk a little more about the support the young person is looking for and whether Brighter Youth is the right service for them. If you're registering someone else, please make sure you've spoken to them first and they know you're doing this. You don't need to tell us everything — just what you think is relevant. 


Before you start


Note
Where counselling is available through school, college or another appropriate service, it may be worth considering whether that service could meet their needs. You can still continue with this registration if you think Brighter Youth may be suitable. 
About who is completing the form

I am registering myself

Please provide details for a parent / carer we can contact for consent.

Please provide details for a parent / carer we can contact.

You are making a professional registration on behalf of the agency or organisation you work for.
Important information for professionals completing this form

**Please check that your browser's autofill feature is not entering information automatically.**

We have received some registrations where browser autofill has inserted incorrect contact details or mixed information from different people.

To prevent this, we recommend turning off autofill before completing the form.

How to turn off autofill:
- Google Chrome: Settings → Autofill and passwords
- Microsoft Edge: Settings → Profiles → Personal info
- Safari: Settings → AutoFill

Please check all information carefully before submitting, particularly the young person's details and contact information.



Where appropriate, the young person’s parent or carer should also be aware of the registration.

You are registering your child or a young person that you care for.


Full details of person being registered for support
For the date of birth select from calendar or type in format DD/MM/YYYY

Please provide the contact details of the person we should get in touch with to arrange appointments. You may have already provided some of these details earlier in the form if it's not with the young person themselves. 

The following questions help us understand who is using Brighter Youth and whether the service is reaching different groups of young people. They are optional and you don't have to answer them.

About the support you are looking for

Other support and relevant information



Privacy, information use and acknowledgement
How we use your information

We will keep the information you provide securely and use it to manage this registration, understand whether Brighter Youth is the right service, provide appropriate support and help keep people safe.
Brighter Youth is provided through Families First. As part of the service, we are required to share the young person's name, date of birth and address with Families First.
"You can find out more about how information is used and protected, who it may be shared with and your data-protection rights in our Privacy and Cookies Policy.

If you're a young person, you can also read our shorter How we look after your information page [LINK]
Declaration

Please select today's date.

Thank you for taking the time to complete this form

Contact Information