Wednesday Towcester Youth Clubs
South Northants Youth Engagement (SNYE) run two Wednesday Youth Clubs in Towcester. Our Junior Youth Club is 9 to 12 years. Our Older Youth Club is 13 to 16 years.
Childs Name:
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First Name
Last Name
Date of Birth
*
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What school does your child attend or are they home schooled?
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Emergency Contact Name 1:
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First Name
Last Name
Emergency Contact Number 1:
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Emergency Contact Name 2:
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First Name
Last Name
Emergency Contact Number 2
*
Does your child have any allergies/illnesses?
Is there anything else you feel we should know that will help us to support your child? Eg. Additional needs, disabilities, fears/phobias, social anxiety. This information will be kept confidential, we would like to work with you to ensure we offer the best support to you & your young person without judgment.
In case of an emergency, do you give us permission to seek medical help straight away?
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Yes
No
I agree to my child attending the Youth Club. I acknowledge the need for responsible behaviour and if my child does not follow the groups agreement, then they may be asked to leave.
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Yes
No
Is the young person allowed to leave the Youth Club without an adult?
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Yes, at anytime by themselves.
Yes, at the end of the session with a group of friends.
No, will be collected by an adult (Please complete the next question)
Please list below ALL the adults who could be collecting your child.
Do you allow photo consent for your child, photos will only be used on our social media platforms & promotional material?
*
Yes
No
If your child is 13+, do you give consent for them to join our Wednesday Night Older Youth Club WhatsApp group? The group is to ease the flow of passing on information and communicating between SNYE Youth Support Workers and members of our Wednesday Night Older Youth Club.
Yes
No
My child under 13 years old.
Parent/Guardian Email
*
example@example.com
Signature
*
Date
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Day
-
Month
Year
Date
Print Name:
Submit
Submit
Should be Empty: