brent

Online registration is only available if you are over 16 and live in Brent. If you live in a different borough, please see our borough map

If you are under 16, you can register at an outlet listed on the map. Click here or download the app to see the outlets near to you.

To register online, fill out the form on the right and we’ll email you with the information you need to complete your registration.

All information is confidential and will not be shared. We will not store or share your address or post anything to you unless you ask us to.

 

 

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
Confirm Email Address
Condom Demonstration
Please tick to confirm you have watched the Condom Demonstration.
Data Protection
Please tick to confirm that you agree to your data being used for the purposes of the Come Correct Scheme and that you agree to abide by the Terms and Conditions. Show Statement



Resident of Borough *
Mobile Number