Older youth registration form

Older youth registration form

Session information: Boys aged 11+ on Wednesdays, 5:30pm-7pm / Girls aged 11+ on Thursdays, 5:30pm-7pm during term time.
Name of child (1), school year, school name and age (e.g. Sam East, Year 7, The Oxford Academy, age 11):
Name of child (2), school year, school name and age (e.g. Sam East, Year 7, The Oxford Academy, age 11):
Name of child (3), school year, school name and age (e.g. Sam East, Year 7, The Oxford Academy, age 11):
Name of parent or carer:

First NameLast Name
Family address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact number:

Area Code (+44)Phone Number
Do any of the children have any medical conditions or accessibility needs that we should know about, please describe if so:
Do any of the children have any dietary requirements or allergies that we should be aware of, please describe if so:
Can we administer pre-approved medication and/or medical aid to your children?
Ethnicity of the children:
Do any of the children receive free school meals?
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. Please check the box below if you give us photo consent:
Do you give photo consent to our registered charity, Rose Hill Junior Youth club:
Where did you hear about us?

Other
Do you want to receive our monthly newsletter with info about activities, trips etc via email?
If yes, please enter your email address:
Form completed on:

MonthDayYear
Date
Should be Empty: