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Youthworks 26/27 Registration Form

Note: If you have signed your child up to The Clubhouse (formerly Learning Hub) we require permission from you to allow us to pick your child up from Hollybank Primary School (if this is where they attend school).

Please insert your email dress

Which programmes are you signing your child up for?

Impact (Girl's Group, Tues 3.30-4.30pm Y8-Y14)

The Clubhouse (formerly Learning Hub, Wed 3-4.30pm P4-P7)

Junior Drop In (Wed evening 6-8pm P4 - Y8)

RAISE (Boy's Group, Thurs 2.30-4pm Y8+)

JYC (2nd and 4th Thurs 7.45 - 9.15pm P6 +)

Saturday Youth Club (Sat 7.30 - 9.30pm Y8+)

Name of Child

Child's Date of Birth

Any medical conditions/allergies we should be aware of?

What is your name?

What is your relationship to the child?

What is your number?

What is your address? (please include postcode)

If your are not available, in the event of an emergency please give an emergency contact number. Name of emergency contact.

Relationship to child

Phone Number

Do you give permission for photos to be taken and put on our social media page?

Yes

Do you give permission for a certified first aider to perform first aid on your child if your child becomes hurt?

Yes

Do you give permission for your child to walk home?

Yes

The Clubhouse Programme - Do you give permission for your child to be picked up from Hollybank Primary School and taken to Monkstown Village Centre on Wednesday Afternoons for The Clubhouse Programme?

Yes

No (I can arrange my child's transport to The Clubhouse)

N/A