Club Sign-up

Details of Attendee

Name of young person

Date of birth

Address

Town/City

Postcode

Does the young person have any medical conditions, mental health conditions, or special educational needs? If applicable, please list.

Dietary needs (Including any allergies)

Is there any additional information we should be aware of?

Details of Parent or Carer

Parent/Carers name

Phone number

Secondary Emergency Contact

We will contact the parent/carer first.

Secondary emergency contact name

Secondary emergency phone number

Clubs Attending

Next Level, Monday 6.30 p.m. to 8 p.m.

LGBT+ Club, Tuesday 5.30 p.m. to 7 p.m.

Young Carers Club, Wednesday fortnightly, 6.30 p.m. to 8.30 p.m.

Canvey Tabletop Teens, Wednesday once a month, 4.30 p.m. to 6.00 p.m.

QT Club, Thursday, 5.30 p.m. to 7.30 p.m.

Sports Club, 4 p.m. to 5.30 p.m at Waterside Leisure Centre, Sommes Avenue

Youth Club, 6 p.m. to 8 p.m.

Demographic information

To provide free clubs and activities for young people, we apply for funding from the local government and trusts. Demographic information of young people is requested by them to ensure services and funding are equitable, representative, and tailored to the needs of the community.

This data is shared anonymously.

Eligible for Free School Meals

Yes

Unkown

Consent

Do you give consent for your child to receive the necessary First Aid Treatment?

Yes

Photo Consent

I consent to my child being photographed while involved in Yellow Door (Canvey Island Youth Project) activities. These may be used in displays and to promote the charity, on websites and social media.

I do not consent to my child being photographed while involved in Yellow Door (Canvey Island Youth Project) activities.

I have read and agree to the Data and Privacy Information below

Paper forms will be kept in a locked cabinet. Membership forms and session registers will also be kept electronically. We will share this information with Essex Youth Service. This data will only be used internally by Essex Youth Service and will not be shared with any other organisation by them. If you are booked onto holiday clubs, your data will also be shared with the Active Essex HAF Programme, our funding partners for the holiday programme. If you would like to see their privacy information, please let us know. The only other time we will share your information or your child’s will be when we are legally obliged to do so, e.g., for safeguarding, or when you give us specific permission. We will use your information • To contact you and your children about the club or activity • To let you and your child know about other Yellow Door clubs and activities. • To let you know about any fundraising events we may be holding. If you would prefer us not to contact you about other activities and/or fundraising events please let us know.