Children & Young People Membership

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Password must contain the following:
  • 12 Characters
  • 1 Uppercase letter
  • 1 Lowercase letter
  • 1 Number
  • 1 Special character

Page 1...

Powerhouse logo
Thanks for wanting to join the Moss Side Millennium Powerhouse family!

Membership gives children and young people access to all our fantastic and free activities like junior/senior youth clubs, sports, drama and creative classes every week. Please answer all of the questions in this form as accurately as possible. The information is for everyone's safety and for organising the sessions. If you are under 15 years old, it must be completed and signed by a parent or guardian.

Remember, you can save your progress and come back to finish it later.
Section 1: Identity of Child / Member
Please upload a face picture of the young person who is named on this membership form. It should be a clear photo with no filters and have no one else in the frame. This is so staff can identify the young people who are accessing our centre and programmes.
Section 2: Demographic & Needs

Health / Disability / Medical conditions
Section 3: Address
Section 4: Supporting Information
Dietary requirements
It is important that you tell us about any dietary issues.
Please tick all that apply. 
Section 5: Parent or Guardian contact details
Person with parental responsibility

Section 6: Emergency contact details (if different to above) 

Page 2...

Powerhouse logo
Section 7: Privacy Statement 

  1) What data we collect
As you become involved with Moss Side Millennium Powerhouse (MSMPH), you will be asked to provide some personal information for our membership and registration systems.  
Initially you will be asked to provide your:
  • Name, address, postcode, and date of birth (this is needed so we know who you are and can track your progress depending on how you are involved)
  • Contact details (this could be your telephone and /or email, this is needed so we can contact you about the activities and opportunities)
  • Gender, ethnicity, sexuality, religion (this is optional and is only needed so we can provide anonymous equality and diversity statistics to potential funders)
You may also be asked to give us information on any medical conditions you may have to help keep you safe when taking part in activities/opportunities either as a volunteer or a participant at our centres.

  2) Why we collect your data
MSMPH will hold your information on a secure database. Your data will only be used for the purposes of monitoring and evaluation for our funders.  This information is kept anonymous.  Your data may be kept for a period of up to 5 years after you stop using our facilities for audit purposes only.
Should you wish to withdraw permission for the use of your data, you can do this at any time and your information will be deleted from our systems.                                     

  3) How we store and share your data
MSMPH will be providing statistics to our funding agencies for monitoring and evaluation purposes – this information will be anonymous. 
MSMPH will not share any personal data with any other third parties except if there are safeguarding issues, and we will attempt to get your permission where possible.

  4) ‎Your Data Rights
For further information on how your personal data will be handled, and your rights, please contact the Data Protection Officer at Moss Side Millennium Powerhouse, 140 Raby Street, Moss Side, Manchester, M14 4SL
Section 8: Consent & Data Protection
Offsite activities:
Please select the appropriate option regarding consent to your child/young person taking part in activities off the premises: 
Activity waiver:
I, the undersigned, hereby state that I wish my child to participate in the sporting activity/exercise class/course/workshop. I realise that their participation in these activities involves potential risk of injury, including but not limited to bodily injury, heart attack, stroke, or even death. I also recognise there are other risks associated with exercise and some activities  and that it is not possible to list every one. I know and understand the risks of exercise, understand that injuries are a possibility, and I hereby assume all risks of injury which could occur by reason of their participation in the activities. I hereby state that my child is in good health and is able to take part in the activity. I take full responsibility for my/our own health and well-being and agree that any instructions received will be used at my/our own risk.
Permission to go home alone (child over 10 only):
Parents and carers must make arrangements for primary school aged children to be brought to and from the Junior Youth Club safely and on time. If a parent or carer is not able to collect their child, they need to let us know in advance who will be doing so. Please indicate below if you give your child permission to leave the premises alone.  I do not hold MSMPH responsible for my child’s safety and actions whilst off the grounds. 
Medical Treatment:
I consent to any emergency treatment necessary during the course of the session and therefore authorise a staff member of MSMPH to sign on my behalf, any written form of consent required by the hospital authorities if the delay in getting my signature is considered by the doctor to endanger my child’s health. 
Photo / Video:
Supervised photos/videos may be taken of your child during activities and used for promotional purposes by MSMPH.  Do you consent to photos/videos being taken of your child?  
GDPR:
I consent to the collection and secure storage of data relating to myself and my child in accordance with data protection regulations as per the full privacy statement above. 
Save my progress and resume later | Resume a previously saved form

Contact Information