Fast-track Registration Request

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This form is for BHY staff or other professionals to submit a referral for fast-track entry to The BHY. If this doesn't apply to you please complete our normal joining form at www.thebhy.co.uk/join

*For professionals filling out this form on behalf of others, please submit the name of the child's parent/carer and their home address and contact details not your own.

Name of Referee (Professional) *

Email Address of Referee (Professional) *

Contact Number of Referee (Professional) *

Please state the reason for a fast-track refererall *

Which BHY Site would you like them to attend? *

Children are able to attend sessions at either site, your choice will be their 'home site'.

BHY BLOOMFIELD : Based at our Youth Centre at 205 Lytham Road, South Shore.

BHY GRANGE PARK : Based at our Youth Centre, 170 Horsebridge Road, Grange Park

Which BHY Section are you applying for? *

INFANTS : (Age 5 to School Year 2)

JUNIORS : (School Year 3 to Year 4)

JUNIOR PLUS : (School Year 5 to Year 6)

SENIORS : (School Year 7 to Year 9)

SENIOR PLUS : (School Year 10 to Year 11)

BHY ACADEMY : Sixth Form / College

Full Name of Young Person *

Young Person's Date of Birth *

YYYY

Gender of Young Person *

Male

Female

Prefer not to say

Other:

Parent / Carer's Full Name *

Relationship of Parent / Carer to the Young Person *

Mother

Father

Foster Carer

Other:

What is their Home Address ... *

and Postcode. *

Please provide a contact Telephone number ... (Parent/Carer) *

and a working email address. (Parent/Carer) *

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