Youth Night

Youth Night Registration
When? Friday 27th November, 7.30-9.00pm

Where? Kinmylies Church, Kinmylies Way, IVP38TP

Who? Secondary Aged Young People

What? Bungee run, table tennis, pool, games, crafts, pizza....a chance to hang out with friends!

There is no cost to come along, but this form must be filled out by a parent or guardian. If you have any questions, contact Anne Gunn by
e-mailing anne@westsideyouthproject.co.uk or phone 07770 720601.
Young person's details
Young person's name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School Year
School
Date of Birth
dd/mm/yy
Details of any health information, allergies or additional support needs
Parent/guardian details

I confirm that the details are correct and complete to the best of my knowledge. In the event of illness, or accident, I give permission for any necessary medical treatment to be given by the nomainted first-aider. In an emergency and if I can't be contacted, I am willing for my child to receive hospital treatment if necessary. I understand that every effort will be made to contact me as soon as possible.
Parent / guardian name

First NameLast Name
Parent/ guardian email
example@example.com
Parent/ guardian contact number
Alternative contact number
My child is under 16 and I give consent for their photo/video to be used for publicity purposes
I am happy to receive information about future events which may suit my child
Signed
Westside Youth Project promises to look after your data in accordance with the General Data Protection Regulation. For more information, e-mail anne@westsideyouthproject.co.uk
Should be Empty:

Youth Night Registration

Young person's details

Parent/guardian details