Blacon Youth Hub Membership Form

BECOME A MEMBER

Before attending Blacon Youth Hub, we need some information about the young person and a parent or carer. This information helps us ensure we understand the needs of the young people who participate in our activities. The details collected will be processed accordance with all applicable data protection laws by Chester FC Community Trust (Charity number 1174370).
CODE OF CONDUCT

In becoming a member of Blacon Youth Hub, you must agree to follow our Code of Conduct.

All members, staff, volunteers and visitors are asked to follow these four simple rules when attending sessions and participating in activities or trips.

Respect yourself
Respect each other
Respect your environment
Respect the team
Young Person Name*

First NameLast Name
Young Person Date of Birth*

DayMonthYear
Date
Young Person Gender*

MaleFemaleOther
Young Person Address*

First Line of Address

Street Address Line 2

CityState / Province

Post Code
School or College*
Young Person Member Agreement*

I wish to sign up as a member of Blacon Youth Hub and agree to participate in activities on or off site. I also agree that I will follow the Blacon Youth Hub Code of Conduct.
Young Person Image Consent

I agree that photos or videos of me may be used for marketing and publicity purposes in printed publications, on social or traditional media, on the Chester FC Community Trust website or by other organisations that want to promote Blacon Youth Hub or Chester FC Community Trust (e.g. schools, funders and partner organisations). If we would like to use your image for other purposes, such as a large campaign or promotion, we will ask you (and your parent/guardian for under 16s) for permission.
Parent or Carer Name*

First NameLast Name
Parent or Carer Email*
example@example.com
Parent or Carer Contact Number*

Area CodePhone Number
Does your child have any food allergies? Please provide details or leave blank if none.
Does you child have any medical conditions or additional needs? Please provide details or leave blank if none.
Is your child allowed to leave junior sessions on their own? All young people are free to leave senior sessions on their own.

YesNo
Parent or Guardian Consent*

I consent to my child becoming a member of Blacon Youth Hub and agree to support its aims and objectives through reminding my child to follow the Blacon Youth Hub Code of Conduct at all times.
Parent of Guardian Signature*

Clear

My Products

Product Name

$ Free Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

BECOME A MEMBER