Registering with Teens Unite is quick, easy and free to do - we just need a few details to get started.

As you're under the age of 18, you will need to inform your parent/guardian that you are registering and that we will contact them initially as part of our welcome process.

Once you have completed the short form below, you will receive an email with the details of what happens next and how to choose your free cap or beanie!

Under 18's Registration Form

First Name:

Last Name:

Birthday

Day

Month

Year

Email:

Mobile Number:

Address line 1:

Address line 2:

County/ Region:

Post Code:

Country:

Gender:

Preferred pronoun:

Ethnicity:

Cancer Diagnosis:

Age when diagnosed:

Where are you in your cancer journey?:

Hospital(s) attending:

Social Worker / Key Worker name:

How did you hear about us?

Name of referee:

This is where you can identify the hospital worker/ social worker/ charity/ friend that let you know

Anything else we need to know?:

Anything else we need to know so we can support you in the best way possible

Parent/ Guardian Contact Details

This is the person we will contact initially once we receive your registration. By completing this registration form, you consent to Teens Unite contacting the above named person.

Parent/Guardian:

Parent/Guardian/ Emergency Contact last name:

Parent/Guardian Email:

Parent/Guardian Phone:

Relationship to you: