Christmas Hangout @The Corner Hub Registration Form
Venue: The Corner Hub, 5 Market Walk, Huddersfield, HD1 2QA Dates/Time: Monday 23rd, Friday 27th, Thursday 2nd January & Friday 3rd January 2025
This form needs completing correctly with factual information preferably by a parent or guardian.
All information will be checked by our team.
Full Name (Young persons name)
*
First Name
Last Name
Date of birth
*
-
Day
-
Month
Year
Date
Age
*
Email
*
example@example.com
Mobile Number
*
Gender
*
Please Select
Male
Female
Non-Specific
Prefer not to say
Address
*
Street Address
Street Address Line 2
City/Town
County
Post Code
Are they in receipt of free school meal (if not they will be required to pay £2.50 on the day)
*
Yes
No
What School / College do they attend?
*
Please Select
All Saints Catholic College, Huddersfield
Brian Jackson College, Heckmondwike
Castle Hall Academy, Mirfield
Colne Valley High School, Linthwaite
Creative and Media Studio School, Huddersfield
Engage Academy, Batley
ES Independent School Kirklees, Huddersfield
Ethos College, Dewsbury
Greenhead College
Holmfirth High School, Thongsbridge
Honley High School, Honley
Huddersfield New College
Joseph Norton Academy, Scissett
King James's School, Almondbury
Kirklees College
Moor End Academy, Huddersfield
Netherhall Learning Campus, Huddersfield
Newsome Academy, Newsome
North Huddersfield Trust School, Huddersfield
Pivot Academy, Cleckheaton
Rastrick High School, Calderdale
Royds Hall Academy, Huddersfield
Salendine Nook High School, Huddersfield
Shelley College, Shelley
St John Fisher Catholic Voluntary Academy, Dewsbury
The Mirfield Free Grammar, Mirfield
Other, out of area
How did you hear about us?
*
Please Select
Event
Facebook
Friend referral
Google
Instagram
Newspaper
Radio
Search Engine
Tik Tok
Emergency Contact First & Last Name
*
Mum/dad/auntie is not acceptable. We need a full name.
Emergency Contact Number
*
This is your parent or guardians contact number .
What is their relationship to the participant?
*
Collection/Drop-off details:
*
I give permission for my child to make their own way to and from each session
Unless notified, a parent or guardian will be dropping off and collecting my child from each session
Book your sessions
Week 1
Tuesday, 23rd December 24
Friday, 27th December 24
Week 2
Thursday, 2nd January 25
Friday, 3rd January 25
Background Information Health and Medical Information we may need to be aware of and other background information
Do they have any allergies or medical conditions?
*
Yes
No
If yes, please explain below, including any medications they may be on:
Do they have dietary requirements
*
Gluten Free
Halal
Vegan
Vegetarian
None
Does your child have a disability or special educational needs?
*
Yes
No
If yes, how would you describe these ?(Please input any SEND details here. Information entered will not affect your ability to make bookings however when you create a booking, please contact the provider to ensure they understand your child’s needs)
How would they describe themselves?
*
Asian
Black
Mixed Heritage
Prefer not to say
White
Other
Back
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Joining the Holiday Provision
This form is to register the participant to the holiday provision delivered in Dec/Jan 2025, which is run by Conscious Youth CIC. We are a not for profit organisation (Registered Company Number: 10532404) which has been set up by local people who make decisions about what happens at the youth club, as well as anything to do with the building and equipment in it.
Media Consent Form
We take your privacy seriously and will only use your personal information for the purposes it was intended. We would like to use material gathered from questionnaires, interviews, to share with our funders Kirklees Council, Department of Education and to use for publicity purposes. Publicity purposes include, but are not restricted to, press releases, leaflets, posters, website and social media channels. By ticking any box below, you agree to share your information and data with us, giving us permission to use as noted above. Please select what information and data you are happy to share with us.
I agree and consent to my photograph being taken and being used for publicity purposes on social media, websites and shared with funders.
I agree and consent to Videos being taken and being used for publicity purposes on social media, websites and shared with funders.
Our organisation will hold this information for no longer than two years and will retain the minimum amount of information it requires to carry out its statutory functions and the provision of services. You have the right to withdraw your consent at any time. Our organisation will not sell, rent, trade or transfer your personal information to outside companies. If you wish to withdraw your consent, you can do so by contacting us via the email address below. We will process your request within ten working days.
Name of signatory:
*
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Thank you for filling in this form and we look forward to welcoming your child to the Christmas Hangout!
Submit
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