Youth_club_registration

Child’s personal details:

Full name of Child

Date of Birth

Gender MaleFemale

Child’s Home address:

Postcode

Parents’/carers’ details/Emergency Contact:

1) Name of the parent/Carer

2) Name of the parent/Carer

Relationship to child:

Home address:

Postcode:

Your email

Telephone

Booking Information:

StudentRefugeeAsylum seekerUnemployed

Child’s medical information/individual needs:

YesNo

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? YesNo

If yes, please give details:

PERMISSION FOR PHOTOGRAPHS AND DIGITAL IMAGES

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 Where you have withdrawn consent, we will securely delete this from our system and use reasonable endeavours to remove your photo/video/recording from any publications already in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: For confidential internal RJ4All use and reporting to funders (e.g. training and monitoring reports)In printed publications and media (e.g. newsletters, reports and website)On RJ4All and our partners' websites and in social media including our online newsletter and reportsNone of the above

I accept terms and conditions