Bedford Radio - Media Youth Group #iwill registration

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Thank you for your interest in our Media Youth Group, our new weekly group to train and support young people with media skills in Bedford.

We hope to do a lot of the paperwork and communications digitally, and at any point please do feel free to contact us. hello@bedfordradio.org.uk or Martin the project manager martin@bedfordradio.org.uk

This is our registration form and should capture all data we need for the project, it will be kept securely and privately, and only shared with project staff & volunteers as needed.

This form MUST be completed by a parent, guardian or carer.

Name of person filling in the form. *

Your contact email address *

Young person name *

Your relationship to the young person *

Name of parents/carers *

Email Address *

Family address *

Young persons school *

Date of birth of the young person *

YYYY

Any medical conditions or allergies that we need to be aware of? *

Any additional or learning support needs we need to be aware of? *

Emergency contact name and phone number *

Are they allowed out by themselves / without adult supervision? (eg to walk home, or work with other young people on the project) *

Anything else we need to know?

Media Capture

The young people will be creating media about themselves, and we will occasionally capture images, audio and video of the group and young people in action, to share with funders, and promote what we are do and promote the group. If this is a problem or there is any reason why this can not happen please do contact us.

I confirm I have the rights and responsibility to be able to complete this form, and it is correct to my best knowledge. (sign with full name) *

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