webPage

Name of Young Person(required)

Date of Birth(required)

Ethnicity

Gender

Mobile no.

Email address

Address

Postcode

Name of school / college

Youth Project attending / enquiring about

Creekmoor Youth Access Point
Number 18, Poole Youth Access Point
Muscliff Youth Access Point
Youth Cafe Project

Name of Parent / Carer

Relationship to young person

Telephone (home)

Mobile no.

Address
(if different from above)

Postcode

Emergency contact Name
(if different from above)

Emergency contact Name

Telephone home

Mobile

Name of Doctors Surgery

Telephone number

Does your child have any medical conditions or requirements we need to be aware of?
(inc. allergies, medical, disability, injuries, religious beliefs etc)

If yes, please give details
(including any medication, they are currently taking)

Photo Consent

Photos taken during club sessions may be displayed in the youth club (which is a shared use building that other organisations / members of the public have access to), or used in marketing and advertising in both printed publications and on internet sites, including social media profile(s).

By checking the box, you consent for the young person named on this form to be:

Photographed

Videod

Declaration

I to the young person named above receiving emergency medical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.
I to being contacted on the number or email provided about club information (for example short-notice closures).
I have completed the form to the best of my knowledge, and I confirm that I am willing to allow the young person named above to attend the above mentioned youth club.
I understand that as parent/carer I remain responsible for the behaviour of my young person at all times and that loss or damage to their property is not covered by the youth centre. Damage to youth centre property, or property belonging to other users, young people or staff remains the sole responsibility of a young person or their carer.
I understand that members are expected to stay on site during the whole session once they have registered and that staff and volunteers are not responsible for their whereabouts if they decide to leave unaccompanied
I understand that I may be contacted to verify information should it come directly for a young person

Signature of Parent/Carer

Print Name

Date Signed

General Data Protection Regulation (GDPR) and Data Protection Act (DPA) 2018
We process your personal information in accordance with GDPR and Data Protection Act 2018. If you would like to know how we use your information, please see our Privacy Notice on the Council's website www.bcpcouncil.gov.uk

In accordance with the DPA 2018 we are required to keep the information we hold about you up to date and accurate. By signing this form you are confirming the information provided by you is correct.

Youth Services Membership Form

BCP Youth Services Membership Form