Door 84 Easter HAF Sign Up Sheet
Please complete the space to secure your child's position 
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Young Person's Name *
Address  *
Postcode *
Date of Birth (Please Note - Door 84 can only work with young people aged 8+) *
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Age *
Gender *
School *
School Year *
Young Person Contact Number  *
Email address of person completing this form
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Does the Young Person have a disability, learning difficulty or health condition?
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Disability details
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Does the Young Person have any allergies?
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Allergy Details *
Does the Young Person require medication whilst at an activity session?
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Medication details
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Does the Young Person have any dietary needs? (Allergies, intolerances, or beliefs)
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Dietary requirements
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Does your child have an Education, Health and Care plan *
Please provide details of the EHCP below
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Is the Young Person working with any other services? (Social Worker, Family Support, Limetrees, The Island etc)
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Other services details
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What is the Young Persons Ethnicity? Ethnicity means the common group or culture that you identify yourself with.
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What is the Young Person's first language?
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Emergency Contact Details 1. (Name, Relation, Phone number)
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Emergency Contact Details 2. (Name, Relation, Phone number)
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Which Area of York does the Young Person Live in? *
Has the Young Person attended Door 84 before?
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Please tick all session(s) that the Young Person wishes to attend during our summer HAF programme. (Spaces are limited and you will be notified by text or email to confirm a space). All sessions are free for children / Young People receiving Free School Meals
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Required
Do you give consent for the use of this child’s photograph & media being used by Door 84? Also, to be used in the public domain such as Newspaper, social media & Website for fundraising and awareness. We may share our photographs and media with other partners and funders.
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Full name of person completing this form
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