Young Person's Registration Form
For club based and online activity
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Email *
Please tick which clubs you attend *
Required
Name of young person *
Address *
Post Code *
Date of Birth **Please note that our activities are for young people aged 8-18, do not proceed if you or your young person does not fall into this age range** *
MM
/
DD
/
YYYY
Phone number *
Emergency Contact Details
Please provide the details of two people that we may contact in the event of an emergency
Name *
Relationship to young person *
Address *
Phone Number *
Name *
Relationship to young person *
Address *
Phone Number *
Medical Information
Do you have a condition that requires medical treatment? *
Do you consider yourself to have a disability? *
If yes, please provide details of any assistance you may require:
Do you currently take any medication *
If yes, please provide details of the medication
Can you self-administer required medication? *
Do you have any allergies? (e.g. food, drinks, medication) *
If yes, please provide details of the type of allergy and the medication used to control the allergy.
Declaration
I agree to the young person participating in Paisley YMCA club activity/online activity via video software e.g Zoom.

I consider that the young person is in good health and capable of taking part in Paisley YMCA club activity/online activity

I agree to the named young person receiving emergency medical treatment as considered necessary by the medical authorities present.

For online activity I agree to be available/close by should the young person experience an emergency situation at home

Once this form has been filled in, it will be stored securely. If you would like to change any details on this form, please let us know and we will retrieve this form for you.
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