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Rye Youth Zone - Registration Form

The information on this form is for the exclusive use of members and youth workers of Rye Youth Zone (RYZ). It is not available to any other individuals or groups. We will not disclose any e-mail address, mobile number or any other details to another individual without your permission. 

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1. Your young person's name *
2. Your young person's date of birth *
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3. Your young person's gender *
4. Your young person's preferred pronoun *
5. Your young person's ethnicity *
6. Language spoken at home *
7. Communication consent
Please read RYZ guidelines about communicating with young people and social media at  https://bit.ly/4jlU5lZ before giving your consent below: *
Required
8. Your young person's mobile number (optional)
9. Your young person's email address (optional)
10. Your young person's school (optional)
11. Your young person's home area
 *
12. Your name (parents or carers) *
13. Your relationship to the young person (parent, grandparent, carer etc.) *
14. Your address (parents or carers) *
15. Your young person's address (if different)
16. Your telephone number (parents or carers) *
17. Your email address (parents or carers) *
18. Medical Information (young person)
Does your young person suffer from any medical conditions (i.e. epilepsy, asthma, diabetes, travel sickness etc.) which we should be aware of?  Write N/A if not applicable. *
19. Food allergies and intolerances (young person)
Please give any details of special dietary needs we should be aware of. Write N/A if not applicable.
 *
20. Disability and Special Needs (young person)
Does your young person have special needs (anxiety, OCD, ADHD, autism, Tourette's Syndrome, learning difficulties, etc) which we should be aware of?
Write N/A if not applicable. *
21. Supporting your young person
How can we support your young person when and if they are having a challenging time?
Write N/A if not applicable. *
22. GP name and practice (young person)
Please give the name of your young person's GP and practice
 *
23. GP phone number
Please give the telephone number of your young person's GP
 *
24. Emergency Medical Treatment
 *
Required
25. Emergency contact person 1's name *
26. Emergency contact person 1's telephone number *
27. Emergency contact person 2's name *
28. Emergency contact person 2's telephone number *
29. Photo consent for media and marketing

Do you agree with the following statement?

I agree to the use of images (still or moving) of my child to be used in printed publications, on videos, media releases, on websites, in adverts or social media produced by or for Rye Youth Zone. This form is valid for 2 years. This form is valid for two years from the date of signing. Consent will expire after this. We will not re-use any images after this time. We will not include personal details i.e. full names, e-mail addresses, or mobile numbers. I have read and understood the conditions of use above.  
 *
Required
30. Permission to register at Rye Youth Zone

Do you agree with the following statements?

I agree to my son/daughter participating in Rye Youth Zone and the activities run by the team.

I understand that every care will be taken to ensure the health, safety and welfare of my child.

I realise and accept that in the event of my child’s behaviour adversely affecting the safety of the activity, the organisers reserve the right to return my child home.

*
Required
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