Registration Form - Summer 2024

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Please complete the Registration Form below. Your child will not be able to take part in any activities without this information.

We collect these details to comply with Safeguarding Standards and to report back to our funders. All information is anonymised and we will never share your personal details with any other third parties. If you have any questions please contact us on info@clitterhouse.com

Name of parent/carer *

Email address (ensure it's the same as eventbrite so we know you have booked and completed this form)
*

Postcode (this information is for our internal monitoring to show funders our reach)
*

Telephone number of parent/carer
*

Name of child 1

Age of child 1

Name of child 2

Age of child 2

Name of Child 3

Age of Child 3

Name of Child 4

Age of Child 4

Name of Child 5

Age of Child 5

Ethnicity (Of young child/ren)

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

Caribbean

African

Any other Black, Black British or Caribbean background

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed or multiple ethnic background

English, Welsh, Scottish, Northern Irish or Britsh

Irish

Gypsy or Irish Traveller

Roma

Any other White background

Arab

Any other ethnic group

Jewish

Any other Jewish background

Is your child/ren registered as disabled/ has Medical Needs / SEN needs / Allergies
*

Yes

If Yes, Please provide details below. We may contact you for further information.

Gender (of young person)

Male (including transgender males)

Female (including transgender females)

Non binary

Gender fluid

Agender

Prefer not to say

Child 1

Child 2

Child 3

Child 4

Child 5

Clear selection

We would like to take photos of the session to help us promote the work we are doing at Our Yard. Give conset

Yes

Clear selection

Has your child/ren been to our Rooted sessions (Spring/Summer 2023) before?

Yes

Not Sure

Clear selection

Full name of person collecting child + mobile phone number
*

Please tick this box to be added to our mailing list (note we only send out newsletters 3-4 times a year)
*

Yes

Required

Submit

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