FUSE Registration form

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Disclaimer: F.U.S.E will use the details given below only for the purpose of registering your child or young person with F.U.S.E. Please proceed by providing the information of the child or young person who will be attending the session, unless the question indicates that a responsible adults information is need within the question. We do not have the right to share this information with any other third party. All information given will be treated with the strictest confidentiality. If you require any more information or have any questions about this disclaimer, please feel free to contact us at info@fuseyouthproject.com

Email *

Please state which site you would like to sign up to

Once you have registered, you will be eligible to attend all of our sites, however we would like to know which site you will be attending mainly

Grahame Park

West Hendon

Stonegrove

Clear selection

Child's First name *

Child's Surname *

Child's Date of Birth *

YYYY

Nickname

Child's Gender *

Female

Male

Prefer not to say

Address *

Postcode *

Young person's Telephone Number

Responsible adults Mobile Number *

Parent/ Carer's email address if under 16?

If over 16 you may include your own email address

Name of school or college *

If not in education please put N/A

Education *

At school

At college

At university

On training scheme/New Deal

Employed

Unemployed

Voluntary work

Other

Other:

Which ethnic group do you identify with? *

Asian Bangladeshi

Asian Indian

Asian Pakistani

Asian Other

Black African

Black Caribbean

Black British

Mixed White & Asian

Mixed White & Black African

Mixed White & Black Caribbean

Mixed Other

Arab

White British

White Irish

White Traveller

White Other

Language spoken at home *

Religion

Would you describe yourself as having any disabilities? *

The young person attending the session

Yes

If yes, how would you describe these?

Do you consider yourself as having any learning difficulties? *

The young person attending the sessions

Yes

Do you have any medical conditions? *

The young person attending the sessions

Emergency contact's name: *

Emergency contact telephone number:

Emergency contacts mobile number: *

Emergency contacts relationship to you *

If your child is under the age of 11 please can you state whether they are going to be collected from the youth club or whether you give them permission for them to go home on their own and let a member of staff know *

Yes he/she is aloud to go home by themselves

No, i will be collecting them

Other:

I provide consent for image(s) of my child who has been named on this registration form to be used for evaluation or promotional purposes by F.U.S.E Youth project, partners and Sponsors. *

Yes

I provide consent for F.U.S.E Youth Project, Partners and Sponsors to store and use the personal details of (name of individual) to be used for evaluation, reporting and telling you about future opportunities. *

Yes

Terms and conditions:

you may withdraw your consent at any time by phoning 07984599139 or by writing to us to let us know if you do not consent anymore. images that have already been published cannot be withdrawn. F.U.S.E Youth Project reserves the right to store and use images indefinitely unless consent is withdrawn.

I understand

I do not understand

Youth Project rules

PLEASE.....

-Respect other children and youth, sports or playworkers and volunteers

-Speak to the workers if you feel uncomfortable or unwell

-Do not damage the building or equipment

-Do not smoke or use offensive language

-Offer new ideas and/or give my opinions if asked

-Leave the premises quietly at the end of the session

I understand

I do not understand

A copy of your responses will be emailed to the address you provided.

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