If you are referring a young person to our programme on their behalf, please use their details
Please register your interest to participate in a KICK programme in your area. This information will be used to demonstrate a need for more KICK programmes in other areas.
First Name
Last Name
Date of Birth
Mobile Number
Email Address
School Name (if applicable)
School Address
13. How did you hear about the programme?
14. Why do you think this young person should do the KICK programme? (can click multiple boxes)
Your name, role and organisation/service
Anything else you would like to tell us?
By signing up you agree to your photo/video to be taken for the purpose and promotion of the KICK programme. Photo's /video's may be posted on SDCP/ KICK/Red Rhino Kickboxing social media platforms and website.