Youth Group Membership Form

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This membership form is to be completed by all parents and carers of the young people who access either Coxhoe or Quarrington Hill Youth Club.

Coxhoe youth club operates in the following age groups- Year 1&2, Year 3&4, Year 5&6 and Seniors (Year 7+) and Quarrington Hill Youth Club is Year 1 - 11.

Which youth club would your child/ren like to access? *

Coxhoe Mini's (Year 1& 2)

Coxhoe Juniors (Year 3 & 4)

Coxhoe Juniors (Year 5&6)

Coxhoe Seniors (Year 7+)

Quarrington Hill Youth Club (Year 1+)

Young Persons Full Name *

Preferred Name

Gender

Female

Male

Prefer not to say

Other:

Clear selection

Child/ren Date of Birth *

YYYY

Child/ren Age *

School Year (2021-22 School Year) *

Young Persons Full Address (Including Post Code) *

Parent / Carer Name *

Parent/ Carer Mobile Telephone Number *

Parent/ Carer Home Telephone Number *

Parent/Carer Email Address *

School *

Registered for Free School Meals *

Yes

Prefer not to say

Medical Conditions/ Allergies

If you leave this section blank, we will presume that your child has no medical conditions or allergies that you are aware of.

Disability / Additional Needs *

Please include any disability which your child has been diagnosed with, including if they are suspected or in the process of being diagnosed.

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