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Lockerley Hive Youth Club: Registration Form

Welcome to Lockerley's Youth Club, The Hive.

Using this form, you can register one young person for either the Juniors (7-11) or Seniors (11-16) sessions.

Young Person's Details

Registering more than one? Please fill the form again.

Name

Date Of Birth

Which Group Will They Join?

Medical Conditions

Medications Required

Dietary Needs

Additional Learning / Support Needs

Parent / Guardian Details

Name

Contact Number

Email Address

Data & Contact Consent

I give consent for my data to be held by Lockerlery & East Deal Memorial Hall, and to recieve communications relating to The Hive Youth Club

Emergency Contact Details

If different from above

Name

Contact Number

Relationship To Young Person

Consents

Participation consent

I give permission for my child to take part in the activities offered by The Hive. I understand that while every care is taken to ensure safety, activities may carry a small level of risk.

Participation consent

Yes

Emergency Medical Consent

In the event of an emergency, I consent to a qualified leader seeking medical treatment for my child if I cannot be contacted.

Emergency Medical Consent

Yes

Photo & Video Consent

I give permission for my child to be photographed or filmed during sessions and for these images to be used:

Parent / Guardian Declaration

Signature

	Yes	No
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