NextGen Towcester
South Northants Youth Engagement (SNYE) run NextGen a group for young adults aged 16 to 19 in Towcester.
Young Persons Name:
*
First Name
Last Name
Date of Birth
*
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name 1:
*
First Name
Last Name
Emergency Contact Number 1:
*
Emergency Contact Name 2:
*
First Name
Last Name
Emergency Contact Number 2
*
Does your young person have any allergies/illnesses?
Is there anything else you feel we should know that will help us to support your young person? 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?
*
Yes
No
I agree to my young person attending NextGen. I acknowledge the need for responsible behaviour and if they do not follow the groups agreement, then they may be asked to leave.
*
Yes
No
Is the young person allowed to leave NextGen without an adult?
*
Yes, at anytime by themselves.
Yes, at the end of the session with a group of friends.
No, will be collected by an adult (Please complete the next question)
Please list below ALL the adults names who could be collecting your young person.
Do you allow photo consent for your young person, photos will only be used on our social media platforms & promotional material?
*
Yes
No
Do you give consent for your young person to join our NextGen WhatsApp group? The group is to ease the flow of passing on information and communicating between SNYE Youth Support Workers and members of NextGen Towcester.
Yes
No
Parent/Guardian Email
*
example@example.com
Signature
*
Date
-
Day
-
Month
Year
Date
Print Name:
Submit
Submit
Should be Empty: