Annual Membership form

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Annual Membership form - 2023/2024

By completing this form you are confirming you have read the information provided and agree to the named young person being a member of Risborough Youth Club. You are also acknowledging the need for them to conform to the Code of Conduct and understand the implications if they are not followed.

Code of Conduct - below is a link to the Risborough Youth Club Code of Conduct.

Code of conduct

Details of Young Person

Full name of young person *

Date of birth *

YYYY

School (If applicable)

School year (If applicable)

Details of Parent/Guardian

Parent/Guardian Full name *

Relationship to Young Person (eg. parent) *

House Name or Number *

Street Name *

Postcode *

Email address *

Emergency contact details

In an emergency, I may be contact on the following:

Telephone number *

If I am not available on the above, please contact:

Full name *

Telephone *

Relationship to young person

Medical Information about Young Person

Any conditions requiring medical treatment, including medication?

Please outline any special dietary requirements or allergies?

Any medication allergies?

Do they suffer from any mental health or behavioural issues?

Medical Declaration

By checking this box I agree to the named young person receiving medication as instructed and any urgent dental, medical, surgical treatment, including anaesthetic or blood transfusion as considered necessary by the medical authorities present.

I agree

Required

Data protection

All information provided on this form is held in the strictest confidence and is destroyed after two years. Information provided to Risborough Youth Club is not shared with any other third parties with the exception of relevant public authorities for the purpose of child protection and safeguarding.

Contacting you

Occasionally, we may wish to contact you via telephone or email in relation to the club. For example, to invite you to an event, such as our annual prize giving evening or to communicate changes in how the club operates. Under the Data Protection Act 2018, your explicit consent is required for this purpose.

Consent *

I consent to being contacted as outlined above

Please do not contact me in the manner above

Photographs and videoing

We would like to obtain your consent for photographing/videoing your ward/son/daughter. These photos and videos will be used to promote the work we do with young people, for example display boards at the club.

Consent *

I do consent to photos or videos to be taken

I do NOT consent to photo or videos to be taken

Additional information

Is there any other information that would be helpful for us to know?

If any changes to the information you have supplied change, please notify Risborough Youth Club immediately.

Please email info@risboroughyouth.club

Gift Aid Declaration for Donations and Subscriptions

I would like to encourage you to complete the ‘Gift Aid’ Declaration Form. We are hoping that all taxpayers will complete this declaration. It will enable us to reclaim some of the tax paid by you, to boost the resources available to us. Making a Gift Aid declaration means that for every £1 you give, in subscriptions or donations, we get an extra 25p from HM Revenue & Customs, helping your donation (including subscriptions) go further. You will not need to supply us with any information relating to your income and you will not be asked to give us any details of your tax office. However, if you are a higher rate (40%) taxpayer then you will also benefit by being able to claim further relief on your self assessment tax form. The declaration does not tie you in for any length of time as it can be cancelled by you at any time. Should your child/children leave the Youth Club then the declaration will be deemed to have expired at the end of the tax year in which they left. If at any time after you have made the declaration you discover that you are/were not a taxpayer then please contact us, as you will need to cancel the declaration.

Gift Aid Declaration

Name of Charity: Risborough Youth Club (Registered Charity No: 1168985)
I want to Gift Aid any donations/subscriptions I make in the future or have made in the past four
years.
I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the
current year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay
any difference.

Please tell us if you;
- Have paid a donation or subscription to us in the past 4 years but you paid insufficient tax on
your income and/or capital gains during that period.
- Want to cancel this declaration.
- Change your name or home address.
- No longer pay sufficient tax on your income and/or capital gains.

If you pay income tax at the higher rate or additional rate and want to receive the additional tax

relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or
ask HM Revenue and Customs to adjust your tax code.

Gift Aid Declaration
Name of Charity: Risborough Youth Club (Registered Charity No: 1168985)
*

I want to Gift Aid any donations/subscriptions I make in the future or have made in the past four years.

I DO NOT want to Gift Aid any donations/subscriptions I make in the future or have made in the past four years.

Required

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