Girls Youth Club Registration

Youth Empowerment CIC

Section 1: Young Person's Details

Full name

Date of birth

Day

Month

Year

Age

School or college

Home postcode

Section 2: Parent / Guardian Details

Parent or guardian full name

Relationship to young person

Mobile number

Email address

Emergency contact full name

Emergency contact number

Emergency contact's relationship to the young person

Section 3: Medical, Additional Needs & Safety

Does your child have any allergies?

Yes

No

Does your child have any medical conditions we should be aware of?

Yes

No

Does your child have any disabilities, additional needs or support requirements we should be aware of?

Yes

No

Is there anything else we should know to help your child participate safely and comfortably?

Section 4: Drop-Off, Collection & Independent Leaving Agreement

Parents or guardians are responsible for dropping their child off at the official start time of the youth club and collecting their child at the official finishing time. Youth Empowerment CIC must be provided with clear written consent from the parent or guardian if they give permission for their child to leave independently at the official finishing time. Without this written consent, the child must be collected by a parent, guardian or authorised adult.

I have read, understood and agree to the drop-off and collection arrangements above.

Do you give permission for your child to leave the youth club independently at the official finishing time?

Yes

No

Is there anyone who is NOT authorised to collect your child? If yes, please provide their full name and any relevant details.

Section 5: Consent

I give permission for my child to attend the Youth Empowerment Girls Youth Club.

I give permission for appropriate first aid to be provided to my child if required during the youth club.

I give permission for Youth Empowerment CIC to contact me regarding my child's attendance, safety and matters relating to the youth club.

Do you give permission for your child to be photographed or recorded during Youth Empowerment activities?

Yes

No

Do you give permission for approved photographs or videos of your child to be used on Youth Empowerment CIC's website, social media, posters and other promotional materials?

Yes

No

Saying no to photography or promotional use will not affect your child's ability to attend the youth club.

Declaration

I confirm that the information I have provided is accurate to the best of my knowledge. I have parental responsibility or appropriate authority to complete this form and give consent for this young person. I give permission for my child to attend the Youth Empowerment Girls Youth Club and agree to the arrangements and consents I have selected above.

Parent / guardian full name

Date

Day