NEWARK YOUTH LONDON ONLINE REGISTRATION FORM

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Newark Youth London has launched a digital service to bring our high quality community and sports work to the community of Tower Hamlets online. We will offer information, advice, and support to reassure the community and help them stay connected. Our Youth Workers and Coaches will run sessions every Tuesday and Wednesday at 5PM-6PM via ZOOM. Sessions will include Information and Workshops, Quizzes, and Physical fitness and Well-being sessions for young people aged 11-19.

PHYSICAL FITNESS AND WELL-BEING -These sessions are aimed at all young people regardless of fitness level, age, or gender and can be completed with small amounts of space.

INFORMATION AND WORKSHOPS - Our workshops, while still fun and engaging will discuss important topics with young people to improve their understanding and resilience in dealing with key issues such as; Dealing with misinformation online, Staying positive (Mental Health, Meditation, and Communication), Staying safe online (Cyber-Bullying, Cyber-security, and Safeguarding), Supporting friends and family, (Language learning, Online Courses, and Volunteering) and Knowing your Rights (Employment, Education and Support).

We are also working hard with other organisations to share activities and opportunities to offer young people with as much support as possible.

WEEKLY SCHEDULE

Tuesday 5pm - Workshops and Informations - 5PM with Nasrin and Khadeja

Wednesday 5pm - Workshops and Informations - 5PM with Nasrin and Khadeja

PLEASE READ THE BELOW DATA USE NOTICE AND COMMUNITY GUIDELINES

PERMISSION:

Please read the statements below and confirm consent below.

I understand that when my child is sharing video and audio, they can be seen/ heard by all other participants and host/staff and they are responsible for what they are saying and sharing with others. (all participants/parents of participants must agree to the following, all staff are appropriately vetted, any safeguarding concerns are reported in-line with policy)

I confirm that all information I provide is complete and accurate to the best of my knowledge and belief.

I give Newark Youth London permission to collect and store information about my child and the services I access for monitoring purposes.

I understand that the data collected may be shared with the London Borough of Tower Hamlets and partner organisations.

I understand that any data collected will be held in accordance with the General Data Protection Regulation.

I consent to the information provided in this form being used for the purposes of processing this application and may be verified with other sources for accuracy.

I consent to the sessions being recorded and stored in line with GDPR regulation

I agree for any multimedia information (e.g. photos/videos) including session recordings or clips to be used for Newark Youth London marketing & publicity material.

I give consent for Newark to contact me by email, SMS, WhatsApp, Phone call or post to inform me about other or new services.

PLEASE ENSURE YOU AND YOU CHILD HAVE READ THE FOLLOWING AND THAT YOUR CHILD AGREES TO THE FOLLOWING

COMMUNITY GUIDELINES;

I will be kind to other participants and always try to help create an atmosphere which celebrates hard work and creativity.
I will not screenshot, record, or photograph anyone without their permission
I will not share any sensitive information which could potential put you or others at risk
I will not bully, intimidate or harass any user.
I will not upload viruses or other malicious code.
I will not solicit login information or access an account belonging to someone else.
I will not post content that: is hate speech, threatening or pornographic; incites violence; or contains nudity or graphic or gratuitous violence.
I will not post unauthorised commercial communications (such as spam).
I will not engage in unlawful multi-level marketing, such as a pyramid scheme.

SAFEGUARDING

Any safeguarding concerns are reported in line with our policy and will be auctioned as appropriate by our safeguarding lead. Please also be aware that staff numbers in the sessions are the same ratio as regular sessions. All sessions are also recorded and stored for safeguarding purposes in line with GDPR regulations.

IF YOU ARE UNDER THE AGE OF 13 YOU REQUIRE PARENTAL CONSENT TO USE THE SERVICE AND TO COMPLETE REGISTRATION. PLEASE SELECT ONE OF THE FOLLOWING ( ALL ANSWERS OTHER THAN EMERGENCY CONTACT SHOULD BE POPULATED USING THE YOUNG PERSONS DETAILS NOT THOSE OF THE PARENT) *

I AM AGED THIRTEEN OR ABOVE AND AM REGISTERING MYSELF

I AM A PARENT REGISTERING MY CHILD

PLEASE STATE YOUR FULL NAME/ THE FULL NAME OF YOUR CHILD *

PLEASE STATE YOUR DATE OF BIRTH/ THE DATE OF BIRTH OF YOUR CHILD *

YYYY

PLEASE STATE YOUR FULL ADDRESS/ THE FULL ADDRESS OF YOUR CHILD *

PLEASE STATE YOUR EMAIL/ THE EMAIL ADDRESS OF YOUR CHILD *

TELEPHONE NUMBER/ THE TELEPHONE NUMBER OF YOUR CHILD *

Do you consider yourself/ your child to have a disability? *

YES

IF YES, please state the type(s) of disability that applies to you/ your child? Please tick all the boxes which apply.

Sensory impairment, (such as being blind / having a visual impairment or being deaf / having a hearing impairment)

Physical impairment, (such as using a wheelchair to get around and / or difficulty using your arms)

Learning disability, (such as Downs syndrome or dyslexia) or

cognitive impairment (such as autism or head-injury)

Mental health condition, (such as depression or schizophrenia)

Long-standing illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)

Other:

What is your/ your child's religious belief? *

No Religion

Agnostic

Muslim

Christian

Jewish

Buddhist

Sikh

Hindu

Humanist

Prefer not to say

Other (please specify below)

Other:

What is your gender? *

Male

Female

Prefer not to say

Other:

How would you define your/ your child's sexual orientation? *

Bisexual (an attraction to both men and women)

Gay man

Gay woman / Lesbian

Heterosexual/Straight (an attraction to opposite sex)

Prefer not to say

Other:

How would you describe your/your childs ethnic origin? *

White British

White Irish

Traveller of Irish Heritage

Gypsy/Roma

Bangladeshi

Pakistani

Indian

Chinese

Japanese

Black African

Black Caribbean

White & Black Caribbean

White & Black African

White & Asian

Other:

Confirm your/ your child's education/ Employment status? *

Full-Time Education

Part- Time Education

Full-Time Employment

Part- Time Employment

Internship

Apprenticeship

Not in Employment or Education

Other:

where do you/ does your child study/ work? *

When did you/ your child's start your/your child's current school/ job? *

If you are currently in school what school year are you in/ what school year is your child in? *

EMERGENCY CONTACT NAME (IF COMPLETING AS A PARENT THIS MUST BE YOU) *

EMERGENCY CONTACT'S RELATION TO YOU (i.e Father, Mother, Grandfather, Stepfather) *

EMERGENCY CONTACT ADDRESS *

EMERGENCY CONTACT TELEPHONE NUMBER *

EMERGENCY CONTACT EMAIL ADDRESS *

Are you/ is your child participating in the Girls in Action Program *

YES

Are you registering as part of the Stepney All Saints D of E program. *

Yes

Are you Registering as part of Newark Half-term Program online sessions 11am-12pm Monday to Friday. *

Yes

Are you eligible for free school meals? *

Yes

What is your/ your Childs's Unique Pupil Number? ( write not known if you don't know it ) *

Who referred you to us? *

PLEASE READ THE CONSENT NOTICE IN THE DESCRIPTION OF THE FORM. PLEASE CONFIRM YOU HAVE READ, UNDERSTAND, AND CONSENT TO THE STATED USE OF YOUR/YOUR CHILD'S DATA AND TO THE TERMS OF USE. *

I AGREE

PLEASE READ THE COMMUNITY GUIDELINES IN THE DESCRIPTION OF THE FORM. PLEASE CONFIRM YOU HAVE READ AND UNDERSTAND THE GUIDELINES AND THAT VIOLATING THESE GUIDELINES CAN RESULT IN YOU/YOUR CHILD BEING BANNED FROM THE SERVICE AND POTENTIALLY ALL OTHER NEWARK SERVICES. *

I AGREE

PLEASE STATE YOUR USERNAME FOR THE SERVICE THIS SHOULD BE YOUR FIRST NAME FOLLOWED BY YOUR LAST INITIAL FOLLOWED BY A NUMBER i.e. WilliamE89 . SPECIFYING YOUR USERNAME BEFOREHAND ALLOWS US TO APPROVE ONLY REGISTERED YOUNG PEOPLE INTO THE SESSIONS, HELP UPHOLD THE COMMUNITY GUIDELINES, AND LINK YOU/ YOUR CHILD TO YOUR INFORMATION IN THE EVENT OF EMERGENCY. (ALL STAFF IN SESSIONS WILL BE IDENTIFIABLE BY THEIR FULL NAMES) *

Do you agree that all information you provide is correct to the best of your knowledge and belief? *

I Agree

I Disagree

Do you give consent for any multimedia information e.g photos/ videos to be used for all LB Tower Hamlets Marketing & Publicity *

I GIVE CONSENT

I DO NOT GIVE CONSENT

Do you give consent for Newark Youth London to contact you by email, SMS, Whatsapp, phone calls or post to inform me about about other or new services? *

I give consent

I do not give consent

PLEASE WRITE YOUR FULL NAME WHICH WILL ACT AS PART OF YOUR DIGITAL SIGNATURE. *

PLEASE CONFIRM TODAYS DATE WHICH WILL ACT AS PART OF YOU DIGITAL SIGNATURE. *

YYYY

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