STARPIC PROJECT

STARPIC PROJECT

Young Person Form

2025
Young Person*

First NameLast Name
Youth (D.O.B)*

DayMonthYear
Date
Youth (Gender)*
Youth (Ethnicity)*
Youth (Safety)*
Youth (School)*
Name of School, Uni
Youth (Doctor)*
Name of medical centre
Youth (Medical)*
Any illness, medical, allergies info here.
Address*

Street Address

Street Address Line 2

CityState / Province

Postcode
Bingham group(s) interested in?*

SPACE (tbc)ACTIVITY (tbc)STARS (tbc)Fri PLAY (p4-s1) 3-5pmSat CULTURE (Families) 10:45-12pmNone
Bingham group(s) interested in?*

Tues (p1-p6/7) 4-5:45pmWed (TBC)Wed (Dance & Movement) 5-6:30pmThurs (p1-p6/7) 4-5:45pmFri (p7+) 3-5pmNone
Summer Fun Activities?*

Week 2 (9, 10, 11th July)Week 3 (16, 17, 18th July)Week 4 (23, 24, 25th July)Week 5 (30, 31, 1st)Week 6 (6, 7, 8th Aug)All The WeeksNone
Niddrie group(s) interested in?*

Wednesday JACK KANE (p4+) 4pmWed (p6/7+) 6-8pmSat CULTURE (Families) 10:45-12pmNONE
Emergency Medical*
I agree to the young person receiving emergency, dental, medical or surgical treatment including a blood transfusion and anaesthetic, as considered necessary by the medical authorities present. I understand reasonable attempts will be made to contact the emergency contacts before administering treatment. Any objections to the administration of blood products should be made via email to Starpic Project.
Parent E-mail*
Enter own email is over 18yrs
How did you find us?*
Facebook / website / school etc
Emergency 1 (Name) *
Emergency 1 (Phone)*
Emergency 1 (Kinship)*
Emergency 2 (Name)*
Emergency 2 (Phone)*
Emergency 2 (Kinship)*
GDPR
As part of our communications activity, Places for People, Starpic Project and all Partnerships may occasionally uses digital images and video for publicity purposes. We would like your permission to digitally photograph/film the person in your care for possible inclusion in our publications, website, social media and other publicity material.
1. The image(s) will remain the property of Places for People, Starpic Project or other partnership colaborators and will be used for the designated purpose of promoting their specific services, aims and values.
2. They may also be used by third parties, contractors and suppliers who have been approved by Places for People or Starpic Project.
3. Permission cannot be withdrawn once images have been used in our publications and other publicity material.

The image(s) / film may be stored electronically for use by other Places for People or Starpic Project employees on request.

For more information on PfP privacy policy visit:www.placesforpeople.co.uk/support-pages/privacy/

I give my permission for Starpic Project and and its subsidiaries/suppliers/contactors to use images or publications and publicity material including (but not limited to) its websites, social media channels, to share the images with external publications such as local newspapers, and for inclusion in the Places for People image library. Images and film footage can also be used in the same way by Places for People’s approved suppliers / contractors, Starpic Project publications and its approaved partnerships including to be contacted via (email, text, WhatApp, letter).
Partnership Consent*
You agree to the above and give permission for Starpic Project partnerships to make contact.
Media Consent*
You agree to the above and give permission for Starpic Project partnerships to make contact.
Outing Consent*
Do you give consent allowing the young person to attend with Starpic Project?
Disclaimer
You are providing your contact details which we may use to infiorm you of any Starpic Project activities. Should you wish to opt out please contact us through the website www.starpicproject.co.uk. Shoiuld the young perosn not attend for THREE sesions they may be removed from the sesion register and the place offered to otherd.

Keep Us Updated
Should any of the information provided in this form change, please complete a new form to help us keep details accurate.

NOTE
Please ensure the young person only brings water or a water bottle (as this can get refilled) to avoid bringing items that could cause allergy or distress to others.
Please use this space for any other information.
Signature*

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