Action for Conservation

Thank you for your interest in WildWEB, our new digital programme to support you and other young people take action while you're in lockdown and continue building momentum around the youth-led environmental movement!

This form should be filled out by the young person interested in joining the WildWEB programme. If you are a parent/carer, please help your child to fill out the form.

Before you complete this form, please speak with your parent/carer and ensure they are happy for you to take part in the programme. After you complete this form, we will seek formal consent from your parent/carer before your place on the programme is confirmed. Once that is complete, we will send you an official welcome pack and you'll be ready to start the programme!

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Name: Email: Comment:

Young person's first name *

Young person's last name *

Young person's date of birth *

Young person's email address *

We will use this email address to contact you about the programme.

Young person's telephone number *

We will use this phone number to contact you about the programme.

Nationality *

The programme is open to young people around the world.

Nearest town/city *

School name (if in the UK)

We may get in touch with your school about our other programmes.

How you would describe your ethnicity?

Ethnicity is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong.

Do you have any learning or accessibility needs?

This could be a special education need, a disability or health condion, or needs related to internet or device access.

Parent/carer name *

Parent/carer phone number *

We will use your parent/carer's phone number to confirm your registration in the programme.

Parent/carer email *

We will use your parent/carer's email address to confirm your registration in the programme.

Do you have access to a garden or balcony? *

YesNo

How much access to data and/or wifi do you have? *

Less than 1 hour per dayBetween 1 and 3 hours a dayMore than 3 hours per day

Which device will you primarily use for WildWEB? *

Shared family computerPersonal computerTablet/iPadMobile phone

How much environmental knowledge do you have? *

Very littleSomeLoads

The programme is open to young people with all knowledge levels, so there is no right or wrong answer here.

How did you hear about the programme? *

Please confirm you are a young person aged 13-17

I confirm

Register for WildWEB!