FEB - Half Term Registration Form
Please complete this form as the parent/guardian of the young person attending. We use this information to keep everyone safe and to contact you in an emergency.
Section 1
Young person details
Young person’s full name
First Name
Last Name
AGE
Gender
Male
Female
Ethnicity
White
Mixed/Multiple
Asian/Asian British
Black/African/Caribbean/Black British
Arab
Other
School year / year group
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
College
Address
Street Address
Street Address Line 2
City
COUNTY
POST CODE
Section 2
Parent/guardian details
Parent/guardian full name
First Name
Last Name
Relationship to young person
Phone Number
Please enter a valid phone number.
Format: 00000000000.
Email address
example@example.com
Section 3
Emergency contact
Emergency contact name
First Name
Last Name
Relationship to young person
Emergency contact phone
Please enter a valid phone number.
Format: 00000000000.
Section 4
Medical / support needs
Does the young person have any allergies or medical conditions we should know about?
Yes
No
If yes, please provide details (including any medication instructions)
Does the young person have any additional needs or support we should be aware of?
Yes
No
If yes, what helps them take part comfortably?
Section 5
Attendance info
Which days will they attend?
Monday
Tuesday
Wednesday
Thursday
Section 6
Consents
Emergency medical consent
I give permission for staff to seek emergency medical help if needed and I understand I will be contacted as soon as possible
Photo/video consent
Yes
No
Collection permission
My child can leave independently
My child must be collected by an adult
Must be collected
Who is allowed to collect? (names + relationship)
Behaviour / code of conduct agreement
I understand my child is expected to follow the youth club code of conduct and staff instructions
Data protection statement agreement
I understand how the club will store and use this information for safeguarding and contact purposes
Parent/guardian name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: