Teenage Group Registration Form

Teenage Groups Registration Form
Which Teenage group are you registering for, please select from the drop down options.*
How did you find out about this group?
Full Name of Young person*

First Name of childLast Name of child
Date Of Birth*

DayMonthYear
Date
Gender
Home Address*

Street Address

Street Address Line 2

TownCounty

Postal Code
Home Landline phone number

Area CodePhone Number
Email address of young person
Young person mobile number
Method Of Travel To Sunrise Multicultural Session*
e.g walk, bicycle or car
Nationality*
African HeritageBangladeshiBlackBlack Caribbean HeritageBlack OtherChineseIndianMixed OriginPakistaniWhite EuropeanWhite UK HeritageWhite OtherOther
Religion (optional)
Mother's/Carers Name*

First NameLast Name
Mothers/Carers Mobile number*
Father's/Carers Name

First NameLast Name
Fathers/Carers Mobile Number
WhatsApp Contact Number (which will be added on a broadcast list to notify of project information)
Please save these mobile numbers in to your phone contacts. Only once you've done this will you be able to receive our WhatsApp broadcast messages.

Boys Youth Club 07934578151

Girls Youth Club 07761152813
Emergency Contacts: Please give details of a person other than the Young persons parents/main carer who may be contacted in the event of an emergency, if the main parent/carer is not contactable for any reason.*

First NameLast Name
Above Emergency Contact mobile number *
Does your young person have any health issues, disabilities that we should be aware of?*
Does the young person have any allergies that we should be aware of?*
Yes I give consentNo I dont give consent
Yes I give consentNo I dont give consent
Yes I give consent.No I dont give consent
YesNo
Teenage Groups Registration Form ONCE REGISTERED WE WILL CALL YOU TO ARRANGE A START DATE
Data Protection Statement

Any information you provide will be used solely to compile Project statistics. From time to time information will be passed onto the Local Education Authority and to local or International funders. These statistics will not allow anyone to be identified.
Please verify that you are human*
Please save these mobile numbers in your phone contacts. Only once you've done this will you be able to receive our WhatsApp broadcast messages.

Boys Youth Club

Girls Youth Club
Should be Empty:

Teenage Groups Registration Form

Teenage Groups Registration Form ONCE REGISTERED WE WILL CALL YOU TO ARRANGE A START DATE

Data Protection Statement