YMCA TG Woolwich Youth Registration Form

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Person completing this form

This form should be completed by a Parent/Carer if young person is under 16. If a young person is 13-15, they may self-consent if parents should not be contacted.

Any young person aged 13-15 who is deemed Gillick competent by staff doesn’t have to seek parental consent if there is a reason they wish not to do so.

Young Person / Child details
Contact information
House/flat number & street
Medical/Dietary Information
i.e.asthma, diabetes, heart condition, back pain etc.
Food allergies and any other allergies e.g. bee sting
The level of reaction and actions required i.e. EpiPen
Please include name, dosage and frequency
Please select from list and add details below
Please summarise the level of support needed to suit additional needs
In addition to what has already been stated
Please provide details of any additional needs diagnosed or not (i.e. anxiety, struggles with reading/writing, autism, ADHD, struggles to concentrate)
Any other emotional, social, educational, health concerns or support needs for you/your child or family?
Parent/Carer 1
If different from address of young person
At least 1 emergency contact must be provided. If this parent/carer is not an emergency contact, a new section will appear where you must enter a second parent/carer who is.
Parent/Carer 2
If different from address of young person
Behaviour Agreement

I understand that I/my child should behave respectfully at all times towards the staff at the YMCA club, the other young people present, the equipment and building. I understand that I/my child should follow any instruction given by staff to ensure the smooth running of club and the safety of all. If I/My child behaves disrespectfully, or doesn’t do what is asked of them by staff I understand that I/they could be asked to leave the club session.


For those under 16 (or 13-15 with self-consent), I understand that if my child is asked to leave the session I will be called to be informed of the situation and I agree to cooperate to ensure they leave the session.


It is our general policy to welcome all young people back to club for the next session, even if they were asked to leave previously, on the understanding that they should be respectful to staff, each other, the equipment and the building.

YMCATG are commissioned by CACT to provide certain youth and children’s services.  As such YMCATG has a contractual, and in some cases legal obligation, to pass certain personal information of users of these commissioned services to the data controller.  More information on the sharing of data can be found in our Privacy Notice for Youth Services at www.ymcatg.org/privacy-notice-youth/ or on the CACT website cact.org.uk/policies.


For more information contact us on 01708 766211 or dpo@ymcatg.org.


We ask that you keep us informed of any changes to the details contained in this registration form. Periodically we may ask you to confirm your details for our records.

Consent
This is to provide positive feedback and communicate to provide the best support for you.
Please note that we will contact the emergency contact immediately
If yes, CACT Consent section to be completed.
CACT Consent

CACT activities may be recorded through photographs and video both for the participant to celebrate their experiences and also for evaluation and promotional purposes. CACT will only ever use your image where you have given us consent to do so.


If you change your mind and wish to withdraw consent for use of your image at any time, please contact kathy.smart@cact.org.uk. If you would like to support CACT by providing consent for us to use your image, please complete this form.

Use of your image for promotional and evaluation purposes may include their use in the following:

  • Website

  • Social Media

  • Printed Material (eg. Leaflets)

  • Press Releases

  • Video

  • Evaluation Reports

  • Funding Bids

  • Case studies

By completing this form you are consenting to us using your personal information for the purposes: CACT would like to collect data for monitoring and evaluation purposes and to safeguard participants. All personal data, including sensitive data*, will be processed fairly and lawfully. All data will be processed securely with appropriate controls in place. Data shared with 3rd parties to fulfil contractual obligations will be processed via secure email. You can find CACT’s full Privacy Notice at cact.org.uk/policies.

 

Terms and conditions:

  • CACT will keep your information on file along with any photo/video footage.

  • In the event that you withdraw your consent for any reason, this information will be removed from our files and destroyed. Images that have already been published cannot be withdrawn.

  • We generally do not use images older than five years.

  • In the event that CACT’s consent policy changes, you will be notified of such changes, and will have the option to revise your preferences with regard to our use of your personal data.

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