One YMCA Youth Membership, Consent & Medical Information Form




LOCATION

Select all that apply. This is just to give us an idea of where we may see you at our activities
MEMBER/YOUNG PERSON DETAILS








Please provide information about any medical conditions, additional needs, allergies or dietary requirements our Youth Workers would need to know for awareness and safety in the club and in the event of an emergency. 

It's important to us that we understand how diverse our membership is so we can ensure everyone is getting a chance to take part. 



MEMBER/YOUNG PERSON CONTACT DETAILS AND ADDRESS







PRIMARY PARENT/GUARDIAN CONTACT 
In the event of an emergency our first call will always be to this parent/guardian.












EMERGENCY CONTACT 
In the event of an emergency our first call will always be to this person.











SECONDARY CONTACT
This should be a different adult aged 18 or above than the primary/emergency contact in the event that they are not available.




Parental Consent (Under 18s)

To enable One YMCA to provide services to you/your child, like every other organisation that provides activities for children and young people, we need to obtain consent from parents, guardians, or carers for their child to participate. It's also important to gather the necessary information to keep children and young people safe during the activity.

Important Information!

If you choose to give One YMCA consent, the information you provide to us may be shared with organisations involved in the delivery of our service, including:

  • Delivery Partners
  • Funding Commissioners
  • Emergency Services and Safeguarding Bodies in the event of a concern

You can withdraw your consent at any time. If you wish to withdraw any of your consents (below) please contact Youthwork@oneymca.org



Young people may be photographed/video recorded when participating in One YMCA Youth activities. This will only take place with the permission of the worker in charge and under appropriate supervision. Images (photo or video) may be used for evaluation, marketing, promotional and publicity in external and internal printed publications and online through our website, partner websites and social media. Please note that we are not able to control re-use where photographs or video have been taken by an outside individual or organisation.

ADDITIONAL INFORMATION




To find out how we use and protect the personal information you may choose to provide to us, please read out privacy notice, which can be found here.


 

Member Consent (18+)

To enable One YMCA to provide services to you/your child, like every other organisation that provides activities for children and young people, we need to obtain consent from parents, guardians, or carers for their child to participate. It's also important to gather the necessary information to keep children and young people safe during the activity.

Important Information!

If you choose to give One YMCA consent, the information you provide to us may be shared with organisations involved in the delivery of our service, including:

  • Delivery Partners
  • Funding Commissioners
  • Emergency Services and Safeguarding Bodies in the event of a concern

You can withdraw your consent at any time. If you wish to withdraw any of your consents (below) please contact Youthwork@oneymca.org



Young people may be photographed/video recorded when participating in One YMCA Youth activities. This will only take place with the permission of the worker in charge and under appropriate supervision. Images (photo or video) may be used for evaluation, marketing, promotional and publicity in external and internal printed publications and online through our website, partner websites and social media. Please note that we are not able to control re-use where photographs or video have been taken by an outside individual or organisation.

ADDITIONAL INFORMATION




To find out how we use and protect the personal information you may choose to provide to us, please read out privacy notice, which can be found here.


 

Contact Information