Ashford Youth Club — Member Registration

Child's Details

First Name *

Surname *

Date of Birth *

Postcode *

Home Address *

Ethnicity / Religion Optional

Medical Needs, Allergies or SEN Optional

GP / Doctor Surgery Contact *

Parent / Guardian — Primary Contact

Full Name *

Mobile / Home Number *

Email Address *

Second Contact — Optional

Full Name

Mobile / Home Number

Email Address Optional

Declarations — Please tick Yes or No for each

I am the parent / guardian of the young person named above and I give consent for them to attend activities organised by the Ashford Youth Club.

I agree that photos and videos can be taken of my child to publicise the group's activities.

I am happy to be emailed or texted with up-and-coming events or important information regarding Ashford Youth Club.

I understand that Ashford Youth Club is NOT responsible for personal belongings.

I give consent for my child to be taken for medical treatment in the event of an emergency.

My child will make their own way home unaccompanied at the end of the session.

Parent / Guardian Confirmation

Print Full Name *

By typing your name above you confirm that you are the legal parent or guardian of the child named on this form, and that all details provided are correct and up to date. It is your responsibility to ensure that Ashford Youth Club is able to contact you in case of emergency.

Please complete all required fields and answer every declaration before submitting.

Ashford Youth Club
Member Registration

Registration submitted!

Ashford Youth ClubMember Registration

Registration submitted!

Ashford Youth Club
Member Registration