surrey

Registration for under 25 years old who live in Surrey

To register online, all you need to do is fill out your details and we will email you information you need to complete your registration. This will allow you  to pick up free condoms at any participating outlet across Surrey.

Under 16 year old? You can still register for c-card

Please note if you are under 16, you can register for a c-card by visiting your nearest outlet that provides the registration service. Find outlet near you.                    

All information is secure and confidential, no details will be passed to your parents / carers, your school, college or Doctors.

 

 

about you

Please complete all the required fields below. Any blue fields are optional.

Initial  & Surname
 
Date Of Birth
/ /
Gender
Ethnic Background
Sexual Orientation
Postcode

Please enter Postcode and click 'Lookup'.

Why we ask for your postcode? (show)

How did you hear about the Scheme?

Email Address
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Condom Demonstration
Please tick to confirm you have watched the Condom Demonstration.
Data Protection

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Resident of Borough *
Mobile Number