NB Youth Project Consent & Registration

NB Youth Project Consent & Registration
Please complete the following which will help us with funders and our own data. Thank you. (tick all that apply)

Our household earns less than £18,010 per yearMy child receives free school mealsMy child has a learning difficultyMy child has a disabilityThere is one or more children under 5 in our householdMy child lives away from their birth parentsMy child has poor mental healthMy child has low attainment or poor attendance at schoolMy child is a young carerI (parent/guardian) and any other adult whom your child is listed as a dependant are not in full time employment.My child is looked after by a single parent or guardian
Young Person's Information
Young person's name*

First NameLast Name
Date of Birth*

MonthDayYear
Please tick whether your child will attend North Berwick, Gullane or both.

North Berwick onlyGullane onlyBoth NB & Gullane
Young person's main address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1
Name*

First NameLast Name
Home Number*

Area CodePhone Number
Mobile Number*

Area CodePhone Number
E-mail*
example@example.com
Parent/Guardian/Emergency contact 2
Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
E-mail
example@example.com
Medical Information
Does your child have any conditions requiring special treatment or medication? If so please detail frequency and dosage below. or state No.*
If your child takes medication will they -*

Self administerI GIVE consent to Youth Project staff administering medication. Eg, EpipenMy child does not take medication
Does your child have any allergies? If so, please detail below or state 'No'*
Has your child received a Tetanus injection in the last 5 years?*

YesNoNot sure
I GIVE consent to my child being administered the following by Youth Project staff, if required. (Tick all you consent to)*

Sun CreamParacetamolAnti HistameneAntiseptic wipesInsect repellantNone of the above
To the best of my knowledge my child is medically fit to take part in activities*

YesNo
I agree to my child receiving emergency medical/surgical/dental treatment as considered necessary by the medical authorities present.*

YesNo
Doctors address*

Practice Name

Practice street number and name

CityState / Province

Postal / Zip Code
Doctors contact number*

Area CodePhone Number
Additional Information

Please give a little information to help us know your child better.
Does your child have additional support needs, special interests, a nickname they prefer to be known by?*
Consent

Please carefully read and respond to the following consent requests.
I GIVE consent and understand that photographs and video may be taken of the participants to use at the Youth Project on displays, Social Media & Website. The coaches/organisations delivering the sessions may also take photograph and video for their own Social Media/advertising. Video and photographs may also be shared with funders and partners.*

YesNo
I GIVE consent to my child taking part in services and activities provided by the Youth Project and understand that there may be some degree of risk. I understand that wherever activities are being led, they are led by experienced and or qualified staff or other organisations hired by the Youth Project.*

YesNo
I have explained to my child that the expected standards of behavior for participation in an excursion or activity and understand that if they jeopardise their own safety or that of others through inappropriate behavior they may be removed from the excursion and any additional costs incurred as a result may be recovered by me.

YesNo
I GIVE consent to my child being transported when appropriate to sessions and activities by minibus, taxi or by staff car which is insured for business use

YesNo
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
To join our informative WhatsApp Chats please follow the links below.

GENERAL NBYP WHATSAPP : https://chat.whatsapp.com/DWvSiWH3xo1AkAdhfGeu92

GULLANE YOUTH CLUB WHATSAPP : https://chat.whatsapp.com/IqALF4tLatpD22dQsiROjF
Signature
Should be Empty:

NB Youth Project Consent & Registration

Young Person's Information

Parent/Guardian 1

Parent/Guardian/Emergency contact 2

Medical Information

Additional Information

Consent