Registration Form Youth Inspired

Name

ForenameSurname

Preferred Name or Nick Name:

If different to forename

Place of education?

School/College name, Home Educated, NEET etc

Age at time of registering

Date of Birth

Date

Gender

Preferred pronouns

Which youth club will the young person mainly be attending?

Date of the first session the young person will attend

Date

Does the young person receive benefit related free school meals?

Is the young person a Young Carer?

Young Persons Email Address or Contact Number (please only add if different from parents/guardians)

example@example.com

Address

Postcode

Ethnicity

Emergency Contact Name

Contact Number 1

Emergency Contact Name 2

Contact Number 2

Parent/Carers Email

example@example.com

Any medical conditions / additional needs / allergies the club should know about, please detail here

Permission of emergency medical treatment if required: (In the event of an emergency and a youth leader is unable to get in touch with) your emergency contact, the club has consent to sign for any medical treatment deemed necessary by a health professional:

Permission for the young person to participate in sport related activities: such as football and other team sports:

Permission for the young person to be in project photographs:

Permission for age appropriate films to be shown:

Is this the first youth club the young person has attended?

Is the young person able to walk home from youth club without someone aged 18+?

Sometimes CYPN works with other youth organisations and local councils. This means you might be invited to activities or events that aren’t run directly by CYPN.To keep you safe at these events, we may need to share important information (like medical details or emergency contacts) with the organisation running the activity.Do you give permission for CYPN to share relevant information with trusted third‑party organisations for medical or emergency purposes only?

Other

Signed

Print Name

Date

We only ask for information so we can run our activities safely and meet our legal responsibilities. We keep your data safe for as long as your child is an active member.
We will only share your information if:
• You ask us to
• The law requires us to
• It’s needed to follow our safety policies, so your child can take part in activities safely
• We’re doing market research to help improve our services
• It’s in the public interest
We never sell your data, and we don’t share it for any other reason.

Clubs for Northamptonshire 8th Earl Spencer Centre Bedford Road, Northampton NN4 7AA

Email: office@cypn.org

Charity registration number 1176739

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A Social Enterprise of the charity Clubs for Young People Northamptonshire

Youth Inspired Registration Form