Parent/Guardian's Name: 


Parent/Guardian Telephone/Mobile: (contact for in case of emergency while club is running) 


Second Emergency contact (name/relationship to young person and phone number):


Youth Name: 


Youth Date of Birth: 

School Year (eg S1):    

School: 
Any allergies or medical conditions we should be aware of:

Town:     
Postcode: 

Please click here to view the Privacy Notice as relates to our use of the information you have provided.

I give permission for these details to be entered on the club database and used as detailed in the Privacy Notice:
Yes    No 
I give permission for these details to be stored after the club to inform me of future activities as detailed in the Privacy Notice:
Yes    No 
I give permission for this young person to be photographed during club activities as detailed in the Privacy Notice:
Yes   No