St James Youth Group Membership Form

St James Youth Group Membership Form
Young Person Information
Name

First NameLast Name
Age
Date of Birth

DayMonthYear
Date
Address

Street Address

Street Address Line 2

CityCounty

Post Code
School
Year Group
Parent/Guardian Information
Parent / Guardian Contact 1
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: 00000000000.
Email
example@example.com
Parent / Guardian Contact 2
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: 00000000000.
Email
example@example.com
Health and Welfare
Name of GP
Names Doctors Surgery
Address of GP or Doctors Surgery

Street Address

Street Address Line 2

CityCounty

Post Code
Does your child have any medical conditions?
Details of the condition and medication required?
Does your child have any allergies or reactions?
Details of any allergies or reations and any medication required
Does your child have any mental health issues, or anxieties of which we should be aware?
Details of condition and medication requiered
Does your child have special needs?
Details of condition and medication requiered
Does your child have a Social Worker
Name of Social Worker
Contact details of Social Worker

Street Address

Street Address Line 2

CityCounty

Post Code
Emergency Medication Agreement
- I give permission for basic emergency first aid to be administered to my child by a Youth Club volunteer if required.
- If my child becomes ill or has an accident that requires emergency treatment, I authorise all medical and surgical treatment, X-ray, laboratory, anaesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency
- For medical emergencies, I allow the medical team of this organisation to take care of my child.
- I release this organisation from any and all liability from accident or injury to the child during the organisation related events.
Parent/Guardian Signature
Photo Identification
Date Signed

MonthDayYear
Date
Behaviour / Code of Conduct Agreement
St James Youth Club should be a safe, happy place for all its members and volunteers. We therefore ask all members to agree to the code of conduct – Please read this through and ensure that your child understands what is acceptable at Youth Club.

Youth Club Code of Conduct
1. These rules are to ensure that everybody attending will be able to have a good time in a safe environment.
2. Behave in a respectful and reasonable way to each other, the adult staff and volunteers. Bad behaviour will not be tolerated. (This includes Bullying, Swearing, Fighting, Racist or offensive language etc.).
3. Drinking of alcohol and the use of drugs ARE NOT permitted. The use of illegal drugs is an offence and will be reported to the Police / parents / guardian / school.
4. Smoking is not permitted on the premises, and young people are asked not to encourage those under the legal age to smoke.
5. Everything at Youth Club is to be shared.
6. Take care of the equipment and the building. If you accidentally break Something then please report it to a member of staff. If you break something deliberately you will be asked to replace it.
7. Look out for the needs of others attending youth club but give space to those that want it.
8. Please join in the Youth Club games and activities, some of which may not be optional.
9. If you can help getting things out and putting them away, then please do so.
10. If you have a problem, then speak to a member of staff or a member of the management team.
Please tidy up after yourself, bins are provided around the hall

If a young person breaks any of the rules, then the Parent/Guardian will be informed of this matter. We may also choose to report anyone breaking these rules to the Police.

If the young person breaks the rules again then we will decide the length of exclusion from the youth club.

St James Church reserves the rights to close the youth club immediately if the safety of the young people attending cannot be guaranteed.
We support Youth Club's rules for acceptable behaviour in person,
I agree that my child will abide by the Code of Conduct of St James Youth Club and will take appropriate responsibility for my child’s actions. I acknowledge that any breach of the code of conduct will lead to my child’s membership and invitation to attend St James Youth Club being withdrawn.
Young Person Signature
Parent/Guardian Signature
Other Consents and Permissions
I give permission for my young person to leave youth club to go to the shop during the youth club session
I give permission for my young person to leave youth club without a parent or guardian or nominated adult at the end of youth club
I give permission for St James Youth Club to take photos and videos of activities our young people take part in. Before taking images of children under the age of 16, we need parent/guardians permission. May we take and use images of your child ( without naming them) for publicity purposes in our newsletters, posters, social media, website or in our reporting back to funders and grant making bodies.
Important Information
Membership forms must be completed in order to attend. Membership forms can be returned at any time.

Once this form is processed and your child is accepted to attend youth club a membership card will be issued to the address on this form.

No child will be able to gain entry to St James Youth Club without a valid membership card.
St James Contact Information
Website: www.stjamesroundsgreen.com

Youth Club Phone Number : 07798787292

Email: stjamesrgyouth@gmail.com

St James Facebook page: https://www.facebook.com/stjamesroundsgreen
Please help us to keep this information up to date - Inform – Chris Sale - St James Youth and Community Regeneration Coordinator if the information changes, or you have any questions.
Should be Empty:

St James Youth Group Membership Form

Young Person Information

Parent/Guardian Information

Health and Welfare

Emergency Medication Agreement

Behaviour / Code of Conduct Agreement

Other Consents and Permissions

Important Information

St James Contact Information