Sign up for our next KICK programme
If you selected all other areas please state your area below
First Name
Last Name
Date of Birth
Mobile Number
Your Email Address
Your 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)
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 and/or KICK Ireland's social media platforms and website.This information will be stored on our data base and only used in the event of an emergency situation. By signing up, you agree that KICK, may collect, use and disclose your personal data as provided in this form, or (if applicable) as obtained by our organisation as a result of your participation, for the following purposes in accordance with the Data Protection Acts, and our data protection policy: a. The administration of your participation with KICK. Please contact us for further details on our data protection policy, including how you may access and correct your personal data or withdraw consent to the collection use or disclosure of your personal data.