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Young Persons Name

Date of birth of Young Person (DD/MM/YYYY)

Address

Email Address

Parent/Guardians Name

Parent/Guardian Phone number

Please add any medical needs of the young person

Please add any dietary requirements including allergies

Please add any information you think would be useful to know

Emergency Contact Name

Emergency Contact Telephone Number

Who will be collecting the young person at the end of the session?

New Field New Field Tick 'Yes' if the young person will be collected at the end of the session Tick 'Yes' if the young person can leave the premises for breaks / lunch? Tick 'Yes' if the young person can go home after the session on their own?

Image Consent Image Consent I give permission for the named young person’s photo to be used for promotional purposes, including but not exclusively social media I give permission for the named young person's video to be used for promotional purposes including, but not exclusively social medai I do not give permission for the named young person's photo or video to be used

Your Data Your Data Please tick 'Yes' to confirm consent to 'your information' Please tick 'Yes' to accept your details being added to our database for future projects