Youth club registration

Welcome to Quinton youth club. Please complete the form for any children attending.

Children attending

Number of children

Parent/Guardian

Name

First name

Please enter a First name

Middle name(s)

Surname

Please enter Surname

Mobile *

Please enter some text

Email *

Please enter a valid email

Address

Address 1

Please enter some text

Address 2

Please enter some text

Address 3

Please enter some text

Town

Please enter some text

County

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Postcode

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Country

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Emergency Contact

Name *

First name *

Please enter a First name

Middle name(s)

Surname *

Please enter Surname

Mobile *

Please enter some text

Medical Information

If you are filling in for more than one child please specify who you are answering for

Photo consent

We will occasionally take photos of our activities and events for our publications. Do you give consent for your child/children's photo to be taken?

Yes

Can your child's image be used on our newletter? *

Yes

Please select at least one of the options

Can your child's image be used on our social media?

Yes

Please select at least one of the options

Can your child's image be used on our website?

Yes

Please select at least one of the options

Leaving club

I give consent for my child/children to walk home from club alone *

Yes

Please select at least one of the options

Consent

I give consent for my child/children to attend Quinton Youth club *

Please enter some text

Date *

Please enter a valid date

Thank you!

Youth club registration

Children attending

Parent/Guardian

Emergency Contact

Medical Information

Photo consent

Leaving club

Consent

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Youth club registration

Children attending

Parent/Guardian

Emergency Contact

Medical Information

Photo consent

Leaving club

Consent

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