Registration Form Youth Inspired

Youth Inspired

Youth Clubs
Name*

ForenameSurname
Preferred Name or Nick Name:
School Young Person Attends
Age
Date of Birth*

DayMonthYear
Date
Which youth club will the young person mainly be attending?*

HartwellDaventryKingsthorpeLitchboroughSprattonKilsbyCrickYouth Club not listed
Date of the first session the young person will attend

DayMonthYear
Date
Does the young person receive benefit related free school meals?*

YESNO
Young Persons Email Address or Contact Number:
example@example.com
Address
Postcode
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:*

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

YesNo
Permission for the young person to be in club photographs:*

YesNoYes but NOT for use on social mediaYes but NOT for use on the website/adverts
Permission for age appropriate films to be shown:*

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

YesNo
Signed*

Clear
Print Name*
Date

MonthDayYear
Date
What will you do with my data? It's simple. We need the information you share with us to run our exciting activities and to satisfy our legal responsibilities We will keep it safe for as long as your child is an active member. We promise well only share your information if: You ask us to,The law requires us in order to comply with our policies so your child can enjoy an activity safely. We carry out market research It's in the publics interest Don't worry we never sell your data or share it for any other reason.

Clubs for Northamptonshire 8th Earl Spencer Centre Bedford Road, Northampton NN4 7AA 07760891181 Email: office@cypnorg Charity registration number 1176739
A Social Enterprise of the charity Clubs for Young People Northamptonshire
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