Membership – Snap Youth

Name *

First

Last

Name Carer/Parent *

First

Last

Address *

Your address and postcode here

Email *

Contact Number *

House/Mobile/Both

Name of Emergency Contact *

First

Last

Emergency Contact Number *

House/Mobile/both

Does the named individual receive free school meals

Yes
No

Equality Information

What is the named person ethnic background?

Equality Information

Does the named individual have a disability?

Yes
No

Equality Information

Does the Individual have a religion or belief

Equality Information

What is the individual's sexual orientation

Equality Information

Leaving the Youth Club to go home *

My child will be walking home alone after the youth club has ended. I understand that I will take full responsibility for my child when the club has ended.
My child will be collected from the Youth Club. I understand that I will be responsible for my child and will ensure that I collect him/her at 7pm prompt. I understand that the youth workers will not be able to wait with my child unless I have arranged this with them at the start of the session.

Leaving the youth club to go to the shop *

I give permission for my child to leave the youth club to go to the local shop
I do not give permission for my child to leave the youth club to go to the local shop

Leaving the youth club to go outside *

I give permission for my child to leave the youth club to go outside
I do not give permission for my child to leave the youth club to go outside

It is important that leaders know of any pre-existing medical conditions (for example asthma, diabetes, heart trouble) which may require treatment, and any condition which may affect participation in any activity. Does the named young person suffer from any pre-existing medical condition requiring treatment? *

Yes
No

Medical Conditions

If 'Yes' please list ailment/s

Medical Conditions

Please list all known allergies to food, drugs or other medication, e.g. antibiotics and plasters

Medical Conditions

Is there anything information, which you believe the leaders should know about the individual?

Photographs and short videos may be taken. These may use these for publicity purposes. Please delete accordingly. *

I give SNaP Development Project permission to use photographs of the named young person
I do not give SNaP Development Project permission to use photographs of the named young person

Photographs and Videos

It is really important that all young people remain safe whilst they take part in activities. As a way of keeping safe all young people are asked to stick to the rules held by the BASE youth club. These rules are:  Listen to instructions.  Do not take what doesn’t belong to you.  Take care of the Youth Club equipment.  No fighting.  No bullying.  Keep clothes on (this means keeping your private parts covered up)  No inappropriate touching of other people  Speak nicely to people.  No running inside the building.  Put litter in the bins provided.  No smoking allowed in the building (this includes E Cigs).  Bikes, scooters and hoverboards are not allowed in the building. Agreement: I have read and understood these rules and I agree to stick to them *

Young Person Signiture

The youth work staff team like to ensure the safety of everyone and will work within a 3 tier warning behavioural management system. If your son/daughter does not respond to the warning system they will be asked to leave the youth club. This may be followed up with the youth worker asking your child to stay away from the club for a number of weeks. If your son/daughter is asked to leave the youth club you will be contacted and an explanation will be given. Please be aware that the youth work staff team will not be responsible for your child once they have left the BASE Youth Club. Agreement: I have read and understood the behavioural management policy and I will take full responsibility for my child when s/he is asked to leave the youth club. I validate the information given above. *

Carer/Parent signature