Full Name of young person (aged 13-19 years only)
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Age of young person
Young person phone number (whatsapp number if possible)
Young person email
Sex/ identity
Please Select
Male
Female
Transgender
Other
Address
Street Address
Street Address Line 2
City
Post code
Who do you live with?
Family
Foster Carer
Supported House
Non-supported House
Alone
With Friends
Hotel/Hostel
Homeless
Name of Parent/ Carer/ Keyworker/ Social Worker
Phone number of Carer
Other Country
Young person Country
*
Please Select
Albania
Ethiopia
Eritrea
Vietnam
Iran
Iraq
Syria
Gambia
Somalia
Yemen
U.K
Brazil
Egypt
Kuwait
Morocco
Bangladesh
Pakistan
India
France
Other country (write below)
Language
Please Select
Arabic
Tigrinya
Amharic
Oromo
Vietnamese
Somali
Pashtu
Dari
Farsi
Sorani
English
Albanian
Spanish
French
Level of English
Please Select
None
Basic
Intermediate
Advanced
When did you come to the UK?
-
Day
-
Month
Year
Date
Name of School/College
Health Issues?
Please Select
No
Yes
Health Details
Do you have a Social Worker?
Please Select
Yes
No
Borough?
Do you have a Solicitor?
Please Select
Yes
No
Back
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RESPECT!!!
Agree
I will respect Staff and volunteers and listen to them
I will be friendly and respectful to everyone
I will respect the Club and look after equipment
I will not fight and won’t get involved if others fight
I will not bring or use drugs, alcohol or weapons
I will come here to have fun and help others have fun
I will help out and keep the Club clean and safe
I agree to:
Tick if you agree
Dost keeping my personal information safely and securely and contacting me about activities or services.
I understand that Dost needs some information to keep me and others safe and understand Dost will only share my information with others who need to know this - for example funders, or if I or someone else is at risk if Dost doesn’t share this info.
Ask to see the information that Dost has about me if I want to see this.
I am aware I don’t need to decide to share any personal information - although this may mean that I am unable to join in activities due to safety.
Dost will delete my information after a certain period of time.
Talk to Marian or other Dost staff, if I am not comfortable at any time during activities - so they can help me feel safe and secure
Receiving emergency medical treatment if my Carer is not available to answer and sharing my Carer’s details
Being filmed or photographed during activities.
I understand photos/film might be used to tell others about what Dost does.
If I don’t agree, Dost won’t use any images of me
Speaking to Staff if I want to make a complaint about something that happens at Dost
I understand that enjoying the actiivities and being safe means I need to follow the rules above
Signature
Submit
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