Become a child or young person member (under 18)

About you as parent/carer

Parent/carer First name

Parent/carer Last name

Parent/carer Email

Preferred title

Parent/carer Phone

Country

Address

City/Town

County

Post code

Your main spoken language

What is your relationship to the child/young person?

Tell us about the child/young person

First name

Last name

Birthdate

Gender

Ethnic group

Main spoken language

If other, please state condition(s)

Do they have a shunt? If so, what type do they have?

If they have a shunt, is it programmable?

How did you hear about Shine?

By becoming a member we will hold your details under legitimate interest. If you'd like to know more about how we look after your information, do look at our privacy policy. You can change the way you hear from us at any time by contacting us via the website or by calling us on 01733 555988.

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