RHJYC Membership Registration Form

Rose Hill Junior Youth club Membership Registration 2025

Complete the form below to sign up for our youth clubs. Session information: School Years 1-3 on Wednesdays, 3:15pm-5:15pm / School Years 4, 5 & 6 on Thursdays 3:15pm-5:15pm.
Child 1 name:*

First NameLast Name
Child 2 name:

First NameLast Name
Child 3 name:

First NameLast Name
Dates of birth for each child (e.g. Lana 12/7/2018)*
School Names (in order of child):*
E.g. Rose Hill Primary (RHPS), John Henry Newman (JHN)
Current school years of all children from September 2024:*
John- Year 1, Katy- Year 5
Do your children receive Free School Meals:

YesNoOther
Ethnicity of children:
E.g. African, Mixed, British
Parent / carer information
Parent/carer name:*

First NameLast Name
Phone Number:*

Area Code (+44 / 07)Phone Number
Name of emergency contact/relationship to child (1):*
Who should we contact if we can't reach you?
Emergency contact number (1):*

(+44 / 07) Area CodePhone Number
Name of emergency contact/relationship to child (2):
Emergency contact number (2):

(44) Area CodePhone Number
Address:*

Street Address

Street Address Line 2

City

Postcode (e.g. OX4 4HF)
Birth Date (Child 1):*

MonthDayYear
Birth Date (Child 2):

MonthDayYear
Birth Date (Child 3):

MonthDayYear
Medical information:
Please list any dietary requirements & allergies (list separately for each child):*
E.g. Halal, Lactose Intolerant / Nuts
Please list any relevant medical information that we should know about and any ways that we can support your child at our sessions (list separately for each child):*
E.g. Additional needs, ADHD, Autism etc
Can we administer pre-approved medication & first aid to your children?*

YesNo
Photo consent and marketing information:
As a registered charity, we are required to evidence our activities by taking photographs and videos for funders, our social media sites and occasional press articles. This consent covers JYC sessions, JYC trips and additional JYC activities. Please check the box below if you give us photo consent:
Photo/video consent options*

Full face/body is okNo identifying features (face)Just hands/back of body (non-identifying)None at all
Where did you hear about us?*

A friendSocial mediaSchoolLocal newsWebsiteOther
Would you like to receive our newsletter which contains information about sessions, activities and trips?*

YesNo
How would you like to receive this information?*

TextEmailI would not like to receive the above information
Email address:
Going home information:
Who will pick the child up?*
Please state 'yes' or 'no' if they can walk home alone:*
Parent/carer submit:
I have filled out this form to the best of my knowledge:

I have read, understood, and filled in the membership form.
If you would like more information about how we store your data, please contact Chris at: Chris@rhjyc.org

Comms & engagement: Aimee - aimee@rhjyc.org
Should be Empty:

Rose Hill Junior Youth club Membership Registration 2025

Parent / carer information

Medical information:

Photo consent and marketing information:

Going home information:

Parent/carer submit: