Young Person Registration

STARPIC PROJECT

Young Person Form

Young Person*

First NameLast Name

Youth (D.O.B)*

Date

Youth (Gender)*

Youth (Ethnicity)*

Youth (Safety)*

Youth (School)*

Enter name of school / education centre.

Youth (Doctor)*

Enter name of medical centre registered.

Youth (Medical)*

Any illness, disability, medical, allergies or dietary needs.

What group are you interested in?*

How did you find Starpic Project?*

Facebook, school, flyer, friends name etc.

Parent E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

City

Postcode

Emergency 1 (Name)*

Emergency 1 (Phone)*

Emergency 1 (Kinship)*

2nd Contact (Name)*

2nd Contact (Phone)*

2nd (Kinship)*

GDPR

As part of our communications activity, Places for People, Starpic Project and all Partnerships may occasionally uses digital images and video for publicity purposes. We would like your permission to digitally photograph/film the person in your care for possible inclusion in our publications, website, social media and other publicity material.

1. The image(s) will remain the property of Places for People, Starpic Project or other partnership colaborators and will be used for the designated purpose of promoting their specific services, aims and values.

2. They may also be used by third parties, contractors and suppliers who have been approved by Places for People or Starpic Project.
3. Permission cannot be withdrawn once images have been used in our publications and other publicity material.

The image(s) / film may be stored electronically for use by other Places for People employees or Starpic Project employees on request.

For more information on PfP privacy policy visit:www.placesforpeople.co.uk/support-pages/privacy/

I give my permission for Starpic Project and and its subsidiaries/suppliers / contactors to use images or publications and publicity material including (but not limited to) its websites, social media channels, to share the image(s) with external publications such as local newspapers, and for inclusion in the Places for People image library. Images and film footage can also be used in the same way by Places for People’s approved suppliers / contractors, Starpic Project publications and its approaved partnerships including to be contacted via (email, text, WhatApp, letter).

Partnership Consent *

You agree to the above and give permission for Starpic Project partnerships to make contact.

Media Capturing Consent *

You agree to the above and give permission for use of images.

PLANNED TRIPS
We will communicate any planned outing trip detail in writting with specific details such as location, timings and the Starpic Projetc conatct. We may make short journeys as part of Starpic Project session, such as to parks, local library, public green space and may use arranged transport for further distances.

Outing Consent *

Do you give consent allowing the young person to attend with Starpic Project?

Emergency Medical *

I agree to the participant receiving emergency dental, medical or surgical treatment, including a blood transfusion and anaesthetic, as considered necessary by the medical authorities present. I understand reasonable attempts will be made to contact the emergency contact(s) before administering treatment. Any objections to the administration of blood products should contact Starpic Project via email.

Disclaimer

You are providing your contact details which we may use to inform you of any STARPIC activities. Should you wish to opt out please contact us through the website www.starpicprojet.co.uk.

Should the young person not attend for THREE sessions they will be removed from the register and the place offered to others.

NOTE

Please ensure the young person only brings water the session as no food of other drinks are permitted. We can refill waterbottles.

Keep Us Updated

Should any of the infomation you have completed change please ensure you inform us and complete a NEW registration form.

Please use this space for any other information.

Signature*