Tuesday Youth Club
Tuesday Youth Club for 9-11 yr olds, run by South Northants Youth Engagement (SNYE). If you have any queries, please contact SNYE Youth Engagement Manager, Penny Embden on 07816 466134.
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?
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Emergency Contact Name 1:
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First Name
Last Name
Emergency Contact Number 1:
*
Emergency Contact Name 2:
*
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 by themselves
Yes, at the end of the session with a group of friends
No, will be collected by an adult (Please list ALL adult names)
Who will your child be collected by?
Do you allow photo consent for your child, photos will only be used on our social media platforms & in promotional material?
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Yes
No
Parent/Carer Email
*
example@example.com
Signature
*
Today's Date
-
Day
-
Month
Year
Date
Print Name:
Submit
Submit
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