Creative Tech Hub - Harrow Registration Form
Please note: all sessions are FREE to attend for young people (aged 13-19, and up to 25 if SEND) who live, study or work in the London Borough of Hammersmith & Fulham. Every Monday & Wednesday Time: 3PM-5PM. Location: WEALDSTONE YOUTH CENTRE, 38-42 HIGH STREET, HARROW, HA3 7AE. Activities include: Music Production, Creative Writing, Filmmaking, Vlogging and Podcasting.
Young Person Details
Please complete this section if you are taking part in the sessions.
Your Name
*
First Name
Last Name
Your Date of Birth
*
Please select a day
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Day
Please select a month
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Month
Please select a year
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Your Gender
*
Male
Female
Non-binary
Prefer not to say
Other
Your Ethnicity
*
Asian or Asian British
Black, Black British, Caribbean or African
White, White British, Gypsy, Irish Traveller or Roma
Mixed or multiple ethnicity
Other
Do you live, study or work in the London Borough of Harrow?
*
Yes
Your Harrow Postcode (Home, School, College or Workplace)
*
Street Address
Street Address Line 2
City
State / Province
Please provide your school, college, sixth form or university name. If you work, please write “Employed” in the box below.
*
Please select the type of education you attend.
*
Primary School
Secondary School
Homeschool
Sixth-form or College
University
I do not study
Other
Name
*
First Name
Last Name
Parent/Guardian Details
Please get your parent or guardian to fill out the rest of this form.
Relationship to Young Person
*
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Mobile Number
*
Format: 00000000000.
Emergency Contact
This must be different to the Parent/Guardian details above.
Email Address
*
Confirmation Email
Emergency Contact Name
*
First Name
Last Name
Relationship to Young Person
*
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Mobile Number
*
Format: 00000000000.
Social Questions
The answers you give will help us better serve your child and demonstrate the need for our services in the local area.
Is your child a looked-after child (LAC/CLA)?
*
Yes
No
Does your child have a social worker?
*
Yes
No
Is your child eligible for free school meals (FSM)? This does not affect eligibility, however it helps us demonstrate the need for our activities.
*
Yes
No
N/A - my child attends homeschool, sixth-form or college
Is your household currently in receipt of Universal Credit, Housing Benefit, Child or Working Tax Credit, Income Support and/or DLA? This does not affect eligibility, however it helps us demonstrate the need for our activities.
*
Yes
No
Medical Conditions, Medications and Allergies
Does your child have any medical conditions or allergies? If yes, please state below information on any medications they take including inhalers, epi pen, antibiotics, blood sugar testing etc. If not applicable, please write N/A.
*
Medical Treatment
As Parent/Guardian of the child named above, I hereby authorise the diagnosis and treatment of my child by a qualified and licensed healthcare professional in the event of a medical emergency. I also give permission to Urban Flyers and its affiliates including Directors, Facilitators and other qualified Staff to provide the required emergency treatment prior to the child’s admission to hospital if applicable. I am aware I will be contacted by Urban Flyers to inform me should this happen.
*
I consent
SEND Requirements
Please confirm if your child has any SEND needs. If yes, please provide further information so we understand how to best support the child/young person during the sessions. If not applicable, please write N/A.
*
Dietary Requirements
Please let us know if your child has any dietary requirements. PLEASE STATE ANY ALLERGIES CLEARLY. If not applicable, please write N/A.
*
Photography & Video
I consent to my child being filmed and pictured during their involvement in the Tech Camp. I understand material may be used online (website/social media) by Urban Flyers and shared with our funders.
*
I consent
Parent/Guardian Signature
Parent/Guardian Name
*
First Name
Last Name
Date
*
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Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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