Membership Form

Sign up for

Membership

at Holmer Green Youth Club

Items marked with * are required.

Young Person's First Name

Young Person's Surname

First line of address

Second line of address

Town

Post Code

Parent Mobile

Parent Mobile 2

Parents Home Email

School

Year Group

Does your child have any allergies or medical conditions? If yes, please give details.

Does your child have special needs? If yes, please give details.

In the case of an emergency, I understand that staff will do everything reasonable to contact the parent/guardian named below.

In circumstances where medical treatment is required immediately and where it is not possible to contact those named in this form, I authorise any of the staff members of the Youth Club to refer to a medical practitioner or emergency services on my/our behalf.

I give permission for HGYC to keep this information until the end of School Year 13 which is when it will be destroyed, or until you ask for HGYC to remove all information.

Parent / Guardian Full Name

Agreement to emergency

I agree

The General Data Protection Act Under the new EU General Data Protection Act we have a legal duty to protect any information we collect from you. We use leading technologies and encryption software to safeguard your data, and keep strict security standards to prevent any unauthorised access to it. We will not pass on your personal details to any third party without your permission.

Holmer Green Youth Club use CCTV on the premises.