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Youth Club Registration Form
Please complete this registration form and submit. All details will be kept in a secure database with access restricted to authorised officers only. This form is to be completed for each child*
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Email
*
Your email
Full Name
Your answer
Age
Your answer
Gender
Female
Male
Prefer not to say
Other:
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Address
Your answer
Post Code
Your answer
Phone Number
Your answer
Emergency Contact Name
Your answer
Emergency Contact Telephone
Your answer
Relationship to Emergency Contact
Your answer
Any allergies or health concerns?
Your answer
Are you taking any medication?
Yes
No
Do we have permission to take photographs/videos for media use only, during attendance with us?
Yes
No
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