Youth Club Registration Form

Registration and Emergency Contact Details

Name of Youth Club (required)

Name of young person (required)

Date of birth (required)

Home Address

Post Code

Home phone number

Mobile phone number

Name of emergency contact

Phone number of emergency contact

Relationship to young person

Medical Information

Allergic to Penicillin?
YesNo
I will inform the Youth Club Leader as soon as possible of any changes in medical or other circumstances between now and the activity start date.
YesNo
In the case of a medical emergency, I agree to my son/daughter receiving medication recommend by the medical authorities present, we will contact you as soon as possible and it will then be the parent/carers responsibility to talk to the medical professionals. I understand also that it is the parent/carers responsibility to collect the young person and take them home. Failure to take responsibility may result in Sheffield Futures staff needing to contact other agencies involved in safeguarding children.
YesNo
If my son/daughter is asked to leave the youth club due to their behaviours, as a parent carer, I will be contacted and agree with the worker the appropriate action to be taken.
YesNo
Any health problems or other allergies that affect participation in activities?

My son/daughter currently taking medication
YesNo
I would like my son/daughter to keep his/her medicine on him/her for use as necessary
YesNo
If yes, please give details – name of medication, dose and time(s) to be taken:

Name and telephone number of doctor (general practitioner):

Is there anything we need to know to make their time on the activity safer and more enjoyable (e.g. travel sickness, behaviour, known phobias, help or supervision needed) or are there any activities which your son / daughter cannot (or should not) participate in?

Activity/Event Photography and Filming Consent

Your rights:
• You have the right to request photos and videos being removed from websites and social media at any time without giving reasons and you will not be penalised for requesting this.
• If your photo is used in printed publications, you have the right to remove the use of the photo in any future publications but not the one in which the photo is printed.
• You have the right to access your photo or video on request.

If we take photos or videos at the event, please provide your consent for Sheffield Futures to use your / your child’s photo or video for non-profit making publicity:
I agree to my child’s photograph being used on the Sheffield Futures website and social media
YesNo
I agree to my child’s photograph being used within printed material (e.g. local press)
YesNo
I agree to my child’s video being used on the Sheffield Futures website and social media
YesNo

How you can help

Our charity is dedicated to helping Sheffield's young people to reach their full potential and achieve the best out of life, whatever their starting point. To help us to do more to support young people and communities we need your help. Just remember, every penny you donate will make a difference.