YMCA Southend Registration Form Parents/Carers

Contact details must be fill out first before attending Southend YMCA Youth Clubs:

This form is for the Parents/Guardians of young people, giving permission for the young person (named below) to attend Southend YMCA Youth Club/Sessions. This information is required for our Emergency Contacts list and Safeguarding purposes, to create a safe environment for everyone. If we are collaborating with other partners who provide a service to a young person, we will share this information with them.

For those who attend the Bridge Youth Space, we will be sharing the data with Southend Vineyard Church for health and safety reasons.

All details of our sessions are listed below please click which sessions the young person will attending, please also confirm if you are picking up the young person for the session or does the young person has permission to return home on their own.

Before filling out this form, please read below and visit the links for our FYV website, photo consent form and our Facebook page.

Please click this link to sign up to our project, "Find Your Voice"! Parents are welcome to sign up too:

https://www.fyv-southend.org.uk

FYV WEB SITE QR CODE

Photo Consent
Please click the link for the photo consent (This is a requirement, we may take photos in sessions)
https://forms.office.com/pages/responsepage.aspx?id=gguuTeTD1kGQbWxZ0FCLWErL9XfYZPBAv0hdW9LxV05UOVAyME5JSDRQWEsyMEVVTzk0NkdCSks3Ny4u&origin=QRCode

QR Code:

Please also add us on Facebook for updates about news of the youth club at Find Your Voice Southend

FYV FACEBOOK PAGE https://www.facebook.com/profile.php?id=61555805283845

For more information on how Southend YMCA processes your particular data, please click here
https://www.southendymca.org.uk/full-privacy-policy

Who is completing this form?

I am a Parent/Carer/GuardianI am a young person aged 13+

Anyone who attends YMCA Southend/Leigh Youth Clubs must sign up to our "Find Your Voice Web Site" for those who are age 13+ can sign up. Those under 13 only parents can sign up. See above links and QR Code.

No, I have not signed up to FYV Web Site (Anyone who attends our sessions needs to sign up to the FYV Web Site)Yes, I have signed up to the FYV Web Site

Photo consent (Please click link above on Photo consent link or scan the QR Code)

I have given photo permissionI have not given permission for any photos to be taken

Photo consent

I have filled out the above link and have given photo permissionI have not given my permission for any photo's to be taken of my childI give permission for my child to give a case study to SYMCAI do not give permission for my child to give a case study for SYMCAI give permission for SYMCA to use my child's name in MarketingI do not give permission for SYMCA to use my child's name in Marketing

Which YMCA Southend activity they wish to attend:

18 to 24 Drop In The Bridge Hub 12:45pm to 2.30pm Wednesday11 to 15 Youth Club The Bridge Hub 3.30pm to 5pm Wednesday15 to 17 Youth Club 5.30pm to 7pm Wednesday11 to 17 Leigh Youth Club 6pm to 8pm ThursdayWeek 1 Youth Champions 13 to 17Week 2 Youth Champions 18 to 24

Name of the Young Person

First NameLast NameKnown by

Birth Date of the Young Person

MonthDayYear

Young person age:

Gender of the Young Person:

Ethnicity of the Young Person:

Ward you live in:

Which School or College they attend:

Address of the young person

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Young Person E-mail

example@example.com

Young Person Mobile Number

Name of the Parent/Carer

First NameLast NameKnown by

Parent/Carer Phone Number

Relationship to young person

Address of Parent/Carer (if different from the young person address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of 2nd Emergency Contact

First NameLast NameKnown by

2nd Emergency Phone Number

Travel arrangements of the young person to the youth activity:

Doctors Address

Doctors Name

Street Address

Postal / Zip Code

Do we need to provide any extra help, for example because of a disability, or are there any activities that your child cannot participate in?

Do we need to know about any medical conditions or allergies? (If yes, please provide details of the condition(s) and any medication needed).

Is there anything else you think we should know?

Agreement

Southend YMCA aims to provide a safe and enjoyable experience for every young person.

To help us do this, please note the following important information.

• All questions on the registration form must be completed and signed by the parent or guardians before any young person takes part, and keep us notified of changes please.

• Parents and guardians must make arrangements for young people to be brought to and from the activity safely and on time.

If a parent or carer is not able to collect their child, they need to let us know in advance who will be doing so by contacting us at fyv@soundymca.org.uk

• We cannot take responsibility for any damaged clothing and/or personal items during the activity.

• Parents and carers should ensure children and young people bring sufficient water, food, clothing, sun lotion and medication (where appropriate) for the duration of the activity.

Dress Code

Young people attending SYMCA Youth Clubs/Sessions, should be dressed in manner that is comfortable and weather appropriate but remembering that this is a place of learning and work, that we have frequent visitors to the Youth Clubs/Sessions and that young people in their appearance and behaviour, both at SYMCA and when travelling to and from SYMCA are representatives of SYMCA and have a duty to help us maintain our positive reputation.

SYMCA is a place of learning and work and we expect attendees to be dressed appropriately. A few specific issues that we would ask for your support with are:

· Shorts/Skirts/Dresses should be close to knee length and smart-casual

· T-shirts should display no inappropriate wording, symbols or logos

· No crop tops/strapless tops/anything too revealing or low/high cut

· No transparent, ‘cut away’ tops or low riding jeans (underwear should not be visible)

If our requests regarding dress codes are not met, we reserve the right to refuse entry to our premises and events and to cancel appointments/sessions/young people’s participation in events at a moment’s notice. This applies to both in-house SYMCA activities and off-site events where young people are representing the SYMCA or attending our provisions.

Safe Space Policy

Alcohol, drugs, vaping, smoking, weapons are not allowed in the building or outside the building, any young person carrying weapons 999 will be called. Any other issues parents/carers will be informed off. No threating, verbal abuse, or bullying of other users of youth clubs, this also includes staff, volunteers and visitors to youth clubs/sessions.

Animals are not allowed in our sessions, only guide/therapy dogs are allowed.

If a young person doesn’t abide by these rules above the following may happen they will be permanently ban from the Youth Space, and the local authorities will be advised.

I agree to (please tick):

My child taking part in the stated activitySYMCA keeping a record of this form for health and safety reasonsAny medical treatment that my child may need to be given in an emergencySYMCA to share information to other partnerships who are working together on the ActivityMy child to understand the rules which will be enforce in the youth club.

Signature of Parent/Carer I understand that my child needs to follow the behaviour code and any safety rules so that Southend YMCA (SYMCA) can keep them and other children safe.

Yes I understand all above

Youth Club Membership Cards