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Full Circle Membership Form - 1 of 2
We want to provide-online spaces &  a place where your needs are respected and where everyone is welcome. We cater for all interests and abilities through delivering a wide range of services designed to help young people fulfil their potential and broaden their horizons.

By becoming a member of Full Circle youth services, you agree to abide by our code of conduct  and we need you to complete the second anonymous equalities and diversity monitoring form (Link in the sign up letter).
You will receive a welcome email and confirmation of membership once it has been received
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Full Circle Youth Services GDPR and Data Protection commitment  to you
At Full Circle Youth services we’re committed to protecting and respecting your privacy and we recognise our responsibility to treat your personal information with care, in line with GDPR legislation. Full Circle Youth Services has put into place, comprehensive but proportionate governance measures to ensure our compliancy to the GDPR regulations.

As part of this process we would like to inform you about the collection and use of your personal information; what it is being collected for, how it will be used, how we keep it stored in a safe and secure manner, when it will be deleted, and what rights you have to your personal information.

If you would like to read our Privacy Statement or read our Data protection policies please contact These will explain our use of your personal information.

If you have any questions about our preparation for GDPR, please contact Ann-Marie Lewis Office Manager and nominated Data Protection Officer. or 01179077164
Name *
Date of Birth *
Address *
Contact Number (if relevant)
What are your interests? *
Which Full Circle Youth services are you joining? *
What School do you  attend? *
Do you live in private rented, owned or social housing? *
1st Parent/Carer's Name *
1st Parent /Carer's Phone Number *
1 st Parent/Carer's Email *
2nd Parent/Carer's Name *
2nd Parent /Carer's Phone Number
2nd Parent/Carer's Email
Emergency contact name and relationship to young  person   *
Emergency contact  number *
Name of Doctors Surgery *
Please give details of any important medical information , conditions, allergies or current medication.
Please give any details of any special dietary requirements.
Is there any additional services we could connect with to  support you  ie young  carer, support worker, mentors, social care or other agencies.
I understand as Parent/Carer it is my responsibility to ensure I update staff of any changes to any emergency or medical  details *
I confirm as Parent /Carer and the young person named  above has read and agreed to abide by Full Circle Youth services code of conduct  -  Please Copy and Paste this link - *
I confirm the Young Person named above will not attend any Full Circle Youth Services session if they, or any member of their household are showing any Covid-19 symptoms. *
I understand as Parent/Carer it is my responsibility to inform the senior or youth lead who will be collecting the young person from each youth session? *
I have read and agreed to follow the  Full  Circle Youth Services Covid-19  guidance.   *
If it becomes necessary for the above Young Person to receive medical treatment and I cannot be contacted to authorise this, I hereby give my general consent to any necessary medical treatment and authorise Full Circle @ Docklands to sign any documents required by the health authorities. *
I give permission that photographs, videos and other recorded information for the young person named above to be used in publicity materials by Full Circle youth services only. *
I give my permission for the young person to take part in local low-risk activities such as visiting local venues (including but not limited to the local park, bowling, cinema, lazer quest, visits to museums, exhibitions and landmarks within 3 miles of Docklands Centre) including the transport to and from the venue where appropriate. I understand that other higher risk activities such as canoeing or trips outside the local area will require additional signed consent forms. *
I confirm that I consent to Full Circle Youth services to  hold and process mine and named young person above personal data in accordance with its Data Protection Policies and Procedures.   *
 I understand that I can withdraw my consent hereby given at any time by notifying Full Circle in writing. *
I would like to be sent the Full Circle newsletter.  
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I have read all of the relevant information provided and agree to young  person named above attending and participating in any youth session delivered by Full Circle @ Docklands Ltd. Please Print Your Full Name as a signature to confirm this statement. *
Queries / questions
Please email to  confirm you have submitted a fully completed  Full Circle- Covid -19 Membership form part 1 & 2, to admin or One of our team will be in contact shortly to send you a welcome letter If you have any other questions, queries or suggestions, please don't hesitate to contact the Judit youth manger on
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