The RJ4All Rotherhithe Community Centre

+44(0)7708758600 Plough Way London SE16 2LJ, UK
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Youth_club_registration

    Restorative Justice for All
    Information recorded here is kept confidential


    Child’s personal details:

    Gender


    Parents’/carers’ details/Emergency Contact:


    Booking Information:

    I am:

    Child’s medical information/individual needs:

    Known medical conditions, allergies, special dietary and health needs:

    If yes, please give details

    Details of any medication being used:

    To the best of your knowledge has your child been in contact with any contagious or infectious diseases, or suffered anything that may be, or become contagious or infectious?

    If yes, please give details:


    PERMISSION FOR PHOTOGRAPHS AND DIGITAL IMAGES

    Please note, we will: never include the full name of the pupil alongside an image only use photo/video/recording with your consent. We do not offer payment for the use of these; only upload or publish photos/videos/recordings which are less than two years old; store and share photo/video/recordings securely making sure we have appropriate safeguards in place if sharing.

    You can:
    contact us at any time if you change your mind and wish to withdraw consent. Where you have withdrawn consent, we will securely delete this from our system and use reasonable endeavours to remove your photo/video/recording from any publications already in circulation;
    ask us for a copy of any photos/videos/recordings or publications where these have been used;

    Please check the relevant boxes below to demonstrate consent and understanding that the images will be used only for educational purposes and that the identity of your child will be protected.

    I consent to the use of my photo/video/recording:

    Please select your answers:

    Consent:


    Please note that: Restorative Justice for All reserves the right to amend the terms/conditions and registration fees at any time.

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