Media Youth Club by Georgina Bobb TV

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This form must be completed by anyone wishing to participate in our Media Youth Club programme.

We are holding a Make Your Own TV Show day at The Albany, Deptford, SE8 4AG and St Hughs Community Centre, Anerley, SE20 8PL for ages 8-15 year olds. Each session has 15 places bookable in advance. Each session is the same activity so no need to book your child in twice!

Please complete the form and make payment via this link to secure your place.

It is £25 for the 2 hour session.

Thank you.

By putting in your contact details via the link you will be added to the parents whatsapp group.

For more information please visit https://georginabobb.tv/media-youth-club

The team can be contacted at hello@georginabobb.tv and 07912345235

Email *

What club will your child be attending *

Weds 29th May at The Albany, Deptford 11am - 1pm ages 8-11

Weds 29th May at The Albany, Deptford 2pm - 4pm ages 12-15

Thurs 30th May at St Hughs Community Centre, Anerley 11am - 1pm ages 8-11

Thurs 30th May at St Hughs Community Centre, Anerley 2pm - 4pm ages 12-15

Childs Details

Name of Child *

Child's Age *

Date of Birth *

YYYY

Childs Home Address *

Parent / Carer Details

Name *

Telephone Number *

Relationship to child *

Emergency Contact

Must be another responsible adult

Name *

Telephone Number *

Relationship to child *

Additional Needs

Does your child have additional/SEND Needs? *

Yes

If yes please give details

Permissions

Do you give Georgina Bobb t/a Media Youth Club permission to record and take photographs of your child/ren for promotional and activity based purposes. This includes social media promotion, website promotion. *

Yes

I hereby consent for my child to take up a place at Youth Media Club, according to our policies and procedures. I have understood the expectations and obligations relating to both my child and myself and I agree to this. By filling your name and date in the boxes below you will have signed. Sign with your full name below. *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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