Shrub End Youth Club - Application Form

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The Shrub End Youth Club is held at St. Cedd's Community Centre on the 2nd and 4th Sunday's of each month between 7-8.30pm. The club is for children in school years 7-11. Please fill out the form below to apply for your child's place. We will contact you to confirm the place. If we have reached capacity we will add you to the waiting list.

Your name: *

Your address: *

Your mobile phone number (this will also be the emergency phone number): *

Your email address: *

Relationship to child: *

Child's name (first and last): *

Child's date of birth: *

YYYY

Do they... *

Live in Shrub End

Attend Paxman Academy

Required

Do they have any allergies or dietary requirements? *

Does your child have any disability or anything that we need to be aware of to help us make their time at the club as enjoyable as possible? *

I consent to photographs being taken of my child while at the Youth Group by a designated leader which will only be used for promotion of the Youth Club. *

I agree

I disagree

I give permission for my child to walk home by themselves when the Youth Club finishes. *

I agree

I disagree

Please tick this box to confirm you understand that if the child fails to attend for 3 sessions in a row their place will be given to someone else. *

I understand

Required

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