Parents & Carers - Sign Up Form If you are the parent or carer of a young person experiencing EBSNA and would like to take part in the Attend Well study, please complete the form below. If you are a young person experiencing EBSNA, please make sure you complete this sign-up form.Please select which best applies to you:(Required) I am a young person aged between 11 and 18 I am the parent of a young person aged between 11 and 18 I'm not a young person or parent/carer How old is your child?(Required)Thank you for your interest in the Attend Well study. This study is open only to parents of young people aged 11 to 18, so you won't be able to take part this time. We really appreciate you taking the time to find out more. If you’d like to hear updates about this study or learn about other opportunities to contribute, you can sign up to our newsletter here: contact form.Thanks for your interest in taking part. This sign-up form is for parents of young people aged 11 to 18 who are finding it difficult to attend school (emotionally based school non-attendance, EBSNA). If you’re a young person aged 11 to 18 experiencing EBSNA, you’re welcome to sign up here: young people's survey.What is your child's name?(Required)What is your child's date of birth?(Required)What is your first name?(Required)Where in the UK do you live?(Required)East MidlandsEast of EnglandLondonNorth EastNorth WestNorthern IrelandScotlandSouth EastSouth WestWalesWest MidlandsYorkshire and the HumberI don't live in the UKWhat is the first part of your postcode?(Required)For example: CB10, PE27, SG1. Please only enter the first part, not the full postcode.What is your email address?(Required) What made you decide to take part in this study?(Required)You don't have to write a lot - just a few words is fine!This field is hidden when viewing the formWhat is your child's favourite thing to do after school?(Required)You don't have to write a lot - just a few words is fine!This field is hidden when viewing the formIP addressPhoneThis field is for validation purposes and should be left unchanged.
