Youth Club Registration

Young Person's Full Name

Date of Birth

Year Group

Young Person's Full Address

Address Line 1

Address Line 2

City

Post Code

Gender

What would your young person like us to call them?

Leave blank if this is the same as their full name.

Parent or Carer's Full Name

Relationship To The Young Person

Contact Number

Email Address

WAVE will use this to contact you about your young person’s membership.

Parent or Carer's Address (Leave blank if you live at the same address as the young person.)

Address Line 1

Address Line 2

City

Post Code

Emergency Contact's Name

Emergency Contact's Phone Number

Doctor's Name

Doctor's Surgery Telephone

Doctor's Surgery Address

Does your young person have any medical conditions, take medication or have a disability we should know about?

Please give us any details WAVE staff need to know to help keep your young person safe.

Does your young person have any allergies? If yes, please give details

Please include food allergies. WAVE is sometimes given food by the community and cannot always guarantee that it is free from allergens.

Is your young person or anyone in your family working with another agency, such as CAMHS or Social Services?

If yes, please provide the agency name and contact details

In an emergency, do you give permission for WAVE staff or volunteers to take your young person to A&E?

Yes

If your young person has a minor injury at WAVE, do you give permission for a trained first aider to provide first aid?

Yes

If your young person or family works with another agency, do you give WAVE permission to share relevant information with them?

Yes

Not applicable, we do not work with another agency

Do you give WAVE permission to take photos or videos of your young person for promotional and fundraising purposes?

Yes

If you select Yes, photos or videos may be used in WAVE reports, brochures, leaflets, posters, Facebook and Instagram

I confirm that the information I have provided is correct and up to date. I will let WAVE know if any details change.

I understand that WAVE will keep the information on this form to manage my young person’s registration and care.

Register your young person with WAVE