Registration Form Youth Inspired

Youth Inspired Registration Form

Clubs for Young People Northamptonshire Youth Clubs
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*

DayMonthYear
Date
Gender*

MaleFemaleNon-binaryTransgenderGender neutralPrefer not sayOther
Preferred pronouns
Which youth club will the young person mainly be attending?*

Youth Advisory Council MemberMember of Youth ParliamentBriar HillSprattonKingsthorpeDaventryKilsbyCrickRothwellWellingboroughHartwellRock Solid Youth Club - Weldon Youth WorkOther
Date of the first session the young person will attend

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

YESNO
Is the young person a Young Carer?

YESNO
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:*

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 project photographs:*

Yes - can be used by third partiesNoYes - Can only be used by Clubs for Young People Northamptonshire (Youth Inspired)
Permission for age appropriate films to be shown:*

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

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

YesNoOnly if lightOnly with friends
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?

YesNoPlease contact myself firstOther
Signed*

Clear
Print Name*
Date

MonthDayYear
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
Newsletter

Yes, subscribe me to CYPN updates (Please note this is separate to individual club information)
A Social Enterprise of the charity Clubs for Young People Northamptonshire
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Youth Inspired Registration Form