Towcester Junior & Senior Youth Clubs
South Northants Youth Engagement (SNYE) run two youth clubs in Towcester. Our Junior Youth Club and our Senior Youth Club.
Which Towcester Youth Club is your young person attending? (Please note, if they're in year 7 they can attend both clubs.)
Junior Youth Club (School Years 5 - 7)
Senior Youth Club (School Years 7 - 10)
Both Junior & Senior (School Year 7 Only)
Young Persons Name:
*
First Name
Last Name
Date of Birth
*
Age
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What school does your young person attend or are they home schooled?
*
Emergency Contact 1's Name:
*
First Name
Last Name
Emergency Contact 1's Number :
*
Emergency Contact 1's Relationship to Young Person:
*
Emergency Contact 2 Name:
*
First Name
Last Name
Emergency Contact 2's Number:
*
Emergency Contact 2's Relationship to Young Person:
*
Does your young person have any allergies/illnesses? (Please note you could also be asked to complete a seperate medical form).
*
Is there anything else you feel we should know that will help us to support your young person? Eg. Additional needs, disabilities, fears/phobias, social anxiety. This information will be kept confidential.
*
In case of an emergency, do you give us permission to seek medical help straight away?
*
Yes
No
I agree to my young person attending the Youth Club. I acknowledge the need for responsible behaviour and if my child does not follow the group's agreement/rules, they may be asked to leave.
*
Yes
No
Is the young person allowed to leave the Youth Club without an adult?
*
Yes, at any time by themselves.
Yes, at the end of the session without an adult but 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 young person. (Anyone not mentioned will be unable to collect your young person).
Do you allow photo consent for your young person? (Photos will only be used on our socials, website & promotional material).
*
Yes
No
If your young person is 13+, do you give consent for them to join our Towcester Senior Youth Club WhatsApp group? The purpos of the group is to ease the flow of passing on information.
Yes
No
Young person is under 13.
Parent/Guardian Email
*
example@example.com
Signature
*
Print Name:
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Submit
Submit
Should be Empty: