YMCA Caring Hearts Sign Up Form

This form is used to collect information about your young person who attends and will be used by YMCA Essex staff. The data you provide to us is securely stored. By submitting this form you confirm that you are happy for YMCA to contact you regarding youth club updates.

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Young person's first name *
Young person's last name *
Do you give consent for photos to be taken and shared by YMCA, our partners & other third parties? Photos may be used for advertising, social media, press releases, reporting & any other youth related materials.  *
Required
Please give any medical details or allergies (please put 'none' if nothing to report) *
Date of birth (day/month/year) *
Parent/carer email address *
Parent/carer phone number *
What School/College do you attend? *
What is the first line of your address (number & road)? *
What is your postcode? *
Who do you care for at home? *
Please give a brief outline of the things you do to support them *
Which areas do you have difficulty with due to you being a young carer? *
Required
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