Youth Club Application form

Youth Club Application Form

Young Person's Full Name(Required)

Young Person's Age(Required)

Young Person's Date of Birth(Required)

DD slash MM slash YYYY

Young Person's Full Address (please include postcode)(Required)

Young Person's Home Number(Required)

If no Home Number please put contact number of Parent/Carer.

Young Person's Gender(Required)

Male

Female

Non-binary

Prefer not to say

Young Person's Ethnicity(Required)

White

Mixed/Multiple Ethnic group

Asian/British Asian

Black/African/Caribbean/Black British

Prefer not to say

Other

(Other) Please specify:

Young Person Doctor Information

This information is needed to support your son/daughter in the case of emergency during participation in any of our face-to-face youth work activity.

Young Person's Doctor’s Name:

Young Person's GP Surgery & Address

Does your son/daughter have any allergies that we need to be aware of?(Required)

Yes

Allergy/Special Dietary Information

Please provide full details of your son/daughter's allergy and/or special dietary requirements.

Please provide in as much detail possible, information about your son/daughter’s allergies and/or special dietary requirements.

Medical Conditions

Does your child have any medical condition/s that we need to be aware of, including disability? If your son/daughter has no medical conditions that we need to be aware of please select 'No' below. Please inform us if there are any changes of information on this form.(Required)

Yes

Please provide full details of any medical condition/s your son/daughter has.

Please provide in as much detail possible, information about your son/daughter medical condition/s

Details of any non-medical issues that we need to be aware of e.g SEN, disabilities, behaviour, phobias, emotional or social challenges

Parent/Carer Contact Details

Parent/Carer Full Name(Required)

Parent/Carer Relationship to Young Person(Required)

Mother, father, sister, carer etc….

Parent/Carer Address(Required)

Same as address as young person

Different address

Parent/Carer Home Number(Required)

Same home number as young person

Different home number

Parent/Carer Mobile Number(Required)

Parent/Carer Email Address(Required)

Alternative Contact Details

Please name an alternative person for us to contact in the event of an emergency. It will only be used if YS is unable to contact the Parent/Guardian.

Alternative Contact Full Name(Required)

Alternative Contact Relationship to Young Person(Required)

Parent/Carer Alternative Address(Required)

Same address as parent/guardian

Different address

Alternative Contact Home Phone Number(Required)

Alternative Contact Mobile Number(Required)

Media Consent

To support our promotional and fundraising activities, we regularly take photos and record films of young people.

I am happy for The Space to take photos/films of my son/daughter.(Required)

Yes

Please note if you have selected ‘YES’ to us taking photos/films of your son/daughter, any photos taken by our staff/partners/volunteers may be used for: Internal reports, Reports to Funders, External Publications (brochures, leaflets, posters etc…) The Space Website and The Space Social Media Sites (Facebook, Twitter, Instagram etc..)

I am happy for The Space to engage via online Youth Work activities with my son/daughter through the use of Social Media platforms (Facebook, Twitter, Instagram, YouTube, Zoom etc) and The Space’s website. This will include participating with photos, video (both Live Stream and pre-recorded), posting, comments etc.(Required)

Yes

Transporting of Young People

The Space offers trips and community events that will link with our projects, The Space will be transported by our staff/volunteers using either personal cars/Charity transport or hired transport.

I am happy for The Space staff/volunteers to provide and transport my son/daughter(Required)

Yes

Keeping you informed

The Space uses a range of methods to contact young people, with information about the activities they are involved with and up and coming activities they could get involved with. These include by letter, email, text message and through social media. Please tick the appropriate box in answer to these questions:

I am happy for The Space to contact me (parent/guardian) about upcoming events, using the contact details I provided above.(Required)

Yes

As the parent/guardian of the aforementioned young person, I have read, fully understood and am satisfied with the details supplied here about The Space’s activities. I agree to my son/daughter taking part in The Space activities.(Required)

Yes – I (parent/guardian) accept the above statement

No – I (parent/guardian) do not accept the above statement

Data Protection Statement

All personal data will be processed by The Space in accordance with the Data Protection Act 1998 & 2018 General Data Protection Regulation and in accordance with The Space’s Data Protection Policy and Guidelines. TS collects this data/information for the following purposes:

To deliver high quality and safe services.
Running and evaluating activities, including contacting parents/guardian when necessary. – Internal purposes such as auditing, evaluation, data analysis, preventing or detecting fraud or error, and research to improve our services and customer communications.
For funder/commissioners’ purposes on reporting who has benefited from working with TS.
Contacting you about TS activities and opportunities that you may be interested in.

Medical information will be shared if this information protects the health and well-being of your son/daughter. TS collect this data in the following way: Consent forms, Referral Forms, (both hard copies and online Microsoft Cloud-based forms) Registers, Session Evaluation Forms, Self-Assessment Forms, Incident Forms, Surveys (both hard copies and online Microsoft Cloud-based and Web-based Surveys) and Outcome Stars. TS stores this data securely both with hard and electronic forms, using encrypted and secure database systems such as IAPTUS. Using encrypted and secure data storage systems such as Microsoft Cloud-based applications such as Teams, SharePoint, Forms and Web-Based applications such as Google Drive & Survey Monkey. Photos and Images will also be stored in this way, but also using Social Media platforms such as Facebook, YouTube, Twitter, What’s App, Instagram and Zoom. Data outcomes and evaluation are stored anonymously and are shared with Funders, Commissioners, Stakeholders and service partners. TS will not hold/store your personal data for longer than is necessary (max of 3 years) for the above purposes. We will not share your personal data with third parties unless legally required to do so. If you have any questions about our data protection policy/procedures, please contact us. Operations Director for The Space is: Doreen Smith doreenthespacecheddar@yahoo.com.

I have read the information about Data Protection, and agree to my son’s/daughter’s personal data being used in the way described above.(Required)

Yes

Please tick the appropriate box in agreement with this statement

Additional Medical Consent

This information is collected to make sure your child can be supported in the event they become unwell, or first aid is required, during any face to face activities with The Space. If they do not bring medication for minor ailments such as headaches, insect bites, blisters, etc with them, it may be necessary for The Space staff/volunteers to administer medication, plasters etc….

Please tick below to give your consent to us providing your son/daughter with the following:(Required)

Painkillers (paracetamol/ibuprofen)

Plasters

Bite Cream

Sun Cream

Tick Removal

Antihistamines (hay fever tablets)

Yes, to all of the above

No, please do not administer any medication or any of the above to my son/daughter

Please tick all that applies

I consent to The Space staff/volunteers taking my son/daughter to A&E, should it become necessary to do so during the course of an activity.(Required)

Yes

This includes any emergency dental, medical or surgical treatment as considered necessary by the medical authorities, in the best interest of your son/daughter’.

I consent to my son/daughter receiving the above necessary medical treatment for any minor injury or illness while engaging with The Space. I also confirm that I will contact The Space if there are any changes to the medical details of my son/daughter or my emergency contact details.(Required)

Yes, I give my consent

No, I do not give consent

Is there anyone that should not have contact with your child that we need to be aware of?(Required)

Yes

If so please give details

Club Rules

In order to keep our club members, visitors and team members safe and happy the members have developed a set of club rules. These should be explained to your child/young person, so they are fully aware of what is expected.

Download the Club Contract