Impact Gamers Mentoring Sign Up
Fill in the form to give consent for your child to come to Impact Gamers FREE sessions and be part of the FREE mentoring scheme.
The process
Parents approach us directly or agencies sign post us

We will visit the home to speak with the parent and the child about the scheme, arrange practicalities of days/times/transport.

If they want to be part of the mentoring scheme this form is completed

Mentoring occurs weekly/fortnightly (depending on situation) from now until November 2020
The mentoring sessions
A staff member will be allocated to each student


2 options

1) Covid19 allows 1:1 support
They will meet for 1-1.5 hours a week/fortnight at our centre at St Stephen's Church Hall BD5 7BH
Sessions will involve game making and mentoring discussions
We will aim to visit the home/speak with the parents at least once every 6 weeks.
1 staff member present, 1 via video call

2) Video call only. We will speak via video chat weekly, any needs for the family we will try and help with
2 staff will be present in the room/call during the mentoring

Discussions will remain confidential, unless there are safeguarding concerns

Free Club Registration form
This form will ALSO register your child for a place at an Impact Gamers as well as the weekly mentoring session funded by West Yorkshire Police & Crime Commissioner Safer Communities fund. So your child could attend the normal open sessions too.

Impact Gamers is based at St Stephen's Church, Bradford BD5 7BH
Name of Child *
Date of Birth *
Weekly time they'd like to attend in term time *
How many people live in your house?
Parents Name/Names *
Contact Phone number for parents (ideally mobile) *
Email contact
Doctor's details (Name and surgery)
Medical Conditions or Disabilities (Write N/A for none) *
During Covid19 how can we contact your child via you?
Other comments
Please read this and consent.
Impact Gamers
Impact Gamers is a community interest company, who aim to inspire young people to make positive computer games. We run groups and events to inspire young people to grow in confidence and skills in computer use and programming. We make games as groups and individuals which are uploaded and shared online for the public to enjoy. Content made in the group belongs to Impact Gamers and we are able to use it to further our aim.

Travel Arrangements
We expect you to be responsible for your child’s travel arrangements to and from the sessions, unless agreed by text/messaging/email with staff members. For any off site activity, we will arrange separate consent.

Maintaining a place at Impact Gamers
Your child can stop attending at any point, but please let us know before you end their place. If the staff feel another group is more suitable or other issues arise from your child's place in a particular group we may switch or end placements.
Missing 3 sessions within 6 weeks may also jeopardise your child's place.

Confidentiality and Data Protection
If young people wish to share information about a difficult part of their life, it will be handled sensitively but not necessarily in confidence. If a young person is, in our opinion, likely to come to some immediate or serious harm, we have a duty of care to disclose relevant details to the proper authorities and members of staff who need to know.
Information is stored on a computer only as long as is necessary.
CCTV is in use in the building, these images are for safety and security
Photos may be taken for publicity,

Our full safeguarding policy can be found online at

First Aid
You give consent for any first aid or emergency medical treatment
I consent. Type your name below as a digital signature *
Funded by Safer Communities
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