My Life Applicaton

To apply, complete the form below as accurately as you can – this will enable us to process your application more efficiently. We require some background information on all Mylife participants. Please give us as much detail as possible about your child’s bullying experiences.

Parent / Guardian Name (required)

Child's Name (required)

Child's Date of Birth (required) | Please enter in the form DD/MM/YYYY

Current Age

Address 1

Town

City

Your Email (required)

Your Phone Number (required)

Please give some details of your child's bullying experiences

Other relevant info (eg school situation, existing referrals, other important info etc.)

MyLife Assertiveness Training is based on a programme known as ZAP Assertiveness Training developed by Kidscape (www.kidscape.org.uk), a UK Charity set up to protect children. We are very grateful that Kidscape has uniquely authorised us to use their concept in Ireland.