New members - Summer youth clubs (ages 5-11)

New members - Summer youth clubs (ages 5-11)

This form is for children who have not attended a JYC youth club or holiday session in the last 6 months. Join us for our free summer youth club sessions at Rose Hill Community Centre. All sessions are drop-off and include lunch. These sessions are drop-off and include lunch. Please choose either a morning or an afternoon session for each week.
Name of child 1

First NameLast Name
Name of child 2

First NameLast Name
Name of child 3

First NameLast Name
Please tell us the ages of all of the children listed on this form
Parent/carer information
Name of parent/carer:

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postcode
Main contact number:

+44Phone Number
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

+44Phone Number
About

Please let us know about your child
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
What school do they attend, or are they home-schooled?
Write home-schooled or the school name.
Going home information

Please let us know whether your child will be picked up or can walk home alone.
Please let us know if any of your children can walk home alone after JYC:
Write YES OR NO. NO = they 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, all JYC holiday clubs, 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
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 options:
Email
example@example.com
My child would like to attend:
Week 1 - Wednesday 5th August
Week 1 - Thursday 6th August
Week 2 - Wednesday 12th August
Week 2 - Thursday 13th August
Week 3 - Wednesday 19th August
Week 3 - Thursday 20th August
During some of the sessions, we might take small groups to our youth club allotment or local nature reserve.

Do we have permission to take your child on a fully supervised visit to local green spaces during the holiday sessions?
Choose:
Should be Empty:

New members - Summer youth clubs (ages 5-11)

Parent/carer information

About

Food allergies and dietary requirements

Medical and accessibility information

First aid at youth club

Going home information

My child would like to attend: