Yoof Club Registration and Consent Form - Jan 2023

Registration & Consent Form [to be completed annually by the YOOF Club Member (18 years and over) or parent/carer of the YOOF Club Member (under 18 years)] Activities will include games, discussion, enlightenment and career sessions, outings and other team building activities

YOOF Club Member's name

Date of birth

Date

Full name of parent/guardian

Home Tel No

Area CodePhone Number

Home address

Parent's/guardian's mobile

Area CodePhone Number

Parent's/guardian's e mail

example@example.com

Name of family doctor

Surgery

School / College

School / College year

Do you/Does your youth have any allergies? (please specify)

Do you/Does your youth have any medical conditions? (please specify)

Are you/is your youth on any medication? (please specify)

Are you/does your youth have any special needs? (please specify)

Is there anything else you would like us to know about you/your youth?

YOOF Club Member's email address

example@example.com

YOOF Club Member's mobile phone number

Area CodePhone Number

Contact tel. no during group or activity time

Area CodePhone Number

Emergency contact details for parents/guardians:

Area CodePhone Number

Contact name for carer / an alternative adult in case of emergencies

Tel no

Area CodePhone Number

Relationship to you/ your youth

Arrangements for collection:

My youth will be brought and collected from YOOF Club

My youth will be collected by

Relationship to your youth

Name(s) of anyone NOT allowed to collect my youth

YOOF Club member has permission to travel to and from YOOF Club without me

Declaration and Consent

I give permission for this YOOF Club member to attend and take part in the specified activities above.

Signed (adult/parent/guardian)

Date

I give my permission for photographs and videos to be taken and used in promotional ways by YOOF Club (they will not be named on photographs)

Signed (adult/parent/guardian)

Date

The information requested on this form can be completed by a carer, but only those with parental responsibility can sign the consent (NB: This may not include a foster carer)