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:*
YesNoContact us first
Ethnicity of the children:
YesNo
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:
Yes, you have consentNo consentYou can take photo/video, but without identifying features (face):
WebsiteSocial mediaSchoolFrom another organisationLocal newsOther
YesNo
If yes, please enter your email address:
Form completed on:

MonthDayYear
Date
Should be Empty: