Registration

Young Person Emergency Contact Details

This information is treated as confidential and used only to contact your parent or carer in the event of an emergency, or to share relevant health information with Level Two youth workers.

Data Controller: Shez Hopkins – Project Manager, Level Two Youth Project.

This information will be used to: contact your parent/carer in the event of an emergency; be shared with Level Two youth workers if they need to know about a health condition; and with other agencies if required by law or if you are considered to be at risk of harm. You have the right to see any information we hold about you, have it corrected or erased.

Personal Details

Young person's full name(Required)

Address(Required)

Postcode(Required)

Home telephone number(Required)

Date of birth(Required)

School name(Required)

Year group(Required)

Parent / Carer Contact

Parent / Carer email address(Required)

Parent / Carer name & emergency contact number(Required)

Health & Additional Information

Any additional needs, medical issues or allergies(Required)

Religion

Ethnicity

Consent

Level Two may take photographs during sessions/activities for publicity purposes (including our website and social media). Are you happy for this to happen?(Required)

Yes, I am happy

Are you happy to receive updates & information via email?

Yes

Declaration(Required)

I have read the Privacy Statement and the information on this form is correct and complete. I understand it is my responsibility to inform and update Level Two of any changes to the above information.