Registration Form


Please complete the form below

Contact Details
These details will be used to contact you and your parent during the programme.
Name *
Date of Birth
Date of Birth
Your Mobile Phone
Your Mobile Phone
No need to include Country Code
We will be contacting this parent during the Programme to remind them of appointments also.
Mobile Phone of Parent *
Mobile Phone of Parent
During the Programme we will send you reminders of upcoming appointments by WhatsApp. *
An Gaisce Award
Do you plan to use this Programme as part of An Gaisce Awards? *
Which Challenges of An Gaisce?
Momentum Leadership meets some of the requirements for An Gaisce Award. See FAQ page for further details.
Are you aware that you will complete only 8 of the Community Involvement weeks with Momentum Leadership and you will need to complete the other 5 weeks by contacting the Charity yourself?
We are happy to facilitate this connection with the Charity but we are not able to accompany you on the remaining Community Involvement Weeks needed to complete the An Gaisce Award.
Are you aware that you complete the 13 weeks of Personal Skill with Momentum Leadership?
Are you interested in doing the Summer Social Project, Croatia - July 1-10, 2020
As part of the programme, we offer participants the possibility of doing a social project in Croatia from July 1-10. Would you be interested in this project.