RHJYC membership form

RHJYC Membership Form

Fill out the form carefully for registration
Name & date of birth
Name of child 1:*

First NameLast Name
Name of child 2:

First NameLast Name
Name of child 3:

First NameLast Name
Birth Date of child 1*

DayMonthYear
Birth Date of child 2:

DayMonthYear
Birth Date of child 3:

DayMonthYear
School information
What school does your child attend?*
E.g. Rose Hill, John Henry Newman...
Current school years of all children listed from Sept 2025:*
E.g. John is year 1, Katy is year 4
Do they receive free school meals?

Yes, they doNoOther
Parent / carer contact information
Name of parent/carer:*

First NameLast Name
Address*

Number & Street (e.g. 12 Carole's Way)

Street Address Line 2

CityState / Province

Postcode (e.g. OX4 4HF)
Main contact number:*

(enter +44)07983972519
Who should we contact if we can't reach you?*
Please include the name of the person and their relationship to the child (e.g. nan, sister, dad...)
Secondary contact number*

Area CodePhone Number
Food allergies and dietary requirements

If your child has any food allergies (e.g. gluten free, lactose intolerant, nuts, fish etc), please list them below.

If your child has any dietary requirements (e.g. vegetarian, halal only), please list them below. Write none if none.
Please list any food allergies and dietary requirements:*
Medical and accessibility information

Please list below any relevant medical information that we should know about and the ways that we can support your child at our sessions (e.g. my child has autism and doesn't like this... my child has ADHD and struggles with... my child has epilepsy and it should be managed this way... my child is allergic to this.)

Write none if none.
Medical information: *
First aid at youth club

If your child is injured at our youth club sessions (e.g. falls over outside, trips and bumps their head/body), can we administer first aid like plasters/bandages and ice packs?

All accidents will be recorded in our accident book and a copy will be given to parents or carers at the end of our session.
First aid*

Yes, you can give basic first aidNo, you can't give basic first aid
Going home information

Our junior sessions end at 5:15pm, but parents/carers are welcome to pick up from 5pm (or earlier, just let us know in advance).

Please let us know who will pick up your child from our youth club sessions. If this list changes, please let us know as soon as possible.

Please let us know if you give your child consent to go home alone after our sessions.
These people can pick my child up from youth club:*
Name & relationship to child (e.g. Mum: Sandra, Dad: Ian).
Please let us know if any of your children can walk home alone after JYC:*
E.g. YES/ NO or Kai can walk home, Harry will be picked up
Data & photo consent

All of the data included on this form is securely stored by RHJYC and will not be shared outside of the organisation without prior consent by the person filling out this form. If you would like to read our GDPR policies, please contact: aimee@rhjyc.org

Photo and video consent:

As a registered charity, we are required to evidence our activities by taking photographs and videos for our funders. These images may be shared by us on our website (rhjyc.org), social media pages/YouTube channel (@rosehilljyc), in our activity reports and occasionally to local press. This consent covers JYC after school sessions, JYC trips, and additional JYC organised activities. You can change your mind about photo consent any time, please get in touch with Aimee.
Consent options*

You can take photos/video of my childYou can take photos/videos of my child, just not their faceNone at all
Newsletter

If you would like to receive our youth club newsletter which contains information about our sessions, activities and trips, please choose how you would like to receive it below.

Email notice: Please check your junk/spam folder, sometimes new emails go into this folder and you could miss it.

You can change how you receive our information any time, please contact Aimee to change this.
Newsletter*

I would like to receive this info by textI would like to receive this info by emailI would not like to receive this infoI already receive this information from you
Email address:
example@example.com
Form completed on:*

DayMonthYear
Date
Should be Empty:

RHJYC Membership Form

Name & date of birth

School information

Parent / carer contact information