Young Persons Development Group

Youth Zone–None–Barking & DagenhamBarnetBarnsleyBlackburnBoltonBristol SouthCarlisleChorleyCreweCroydonGrimsbyHammersmith & FulhamHaringeyManchesterManchester EastOldhamPrestonSalfordThurrockWarringtonWiganWirralWolverhampton

Young Person Details

First Name

Last Name

Street

City

Postcode

Date of Birth (DD/MM/YYYY)

Gender–None–MaleFemaleOtherPrefer not to say

Home Phone

Mobile

Email

School/College/Employer

Ethnicity–None–White – BritishWhite – IrishWhite – Gypsy/Irish TravellerWhite – Other white backgroundMixed – White and Black CaribbeanMixed – White and Black AfricanMixed – White and AsianMixed – Other mixed backgroundAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – BangladeshiAsian or Asian British – other Asian backgroundBlack or Black British – CaribbeanBlack or Black British – AfricanBlack or Black British – other Black backgroundChineseOther ethnic groupArabDon’t knowDon’t want to say

Disability–None–NoYesI don’t know

Additional Needs–None–NoYesI don’t know

Medical Conditions

Any other information you would like us to know?

Emergency Contact Details

Please provide details for two emergency contacts.

Emergency Contact 1

The first emergency contact must be a parent/guardian. If you are under 16, this must be the same person who completes the Parent/Guardian Agreement below.

Emergency Contact 1 Name

Relationship to Young Person

Emergency Contact 1 Phone

Emergency Contact 1 Email

Emergency Contact 1 Address (if different from above)

Emergency Contact 2

The second emergency contact should be another person who can be contacted if the parent/guardian is not available. By providing their information you confirm you have their consent to use their information for this purpose only.

Emergency Contact 2 Name

Relationship to Young Person

Emergency Contact 2 Phone

Emergency Contact 2 Address (if different from above)

Consent

By signing up as a Group member, you (and your parent/guardian for under 16s) give consent for all meetings, trips and activities taking place as part of the Group. Events and meetings may take place at short notice, however whenever possible notice will be given.

Your personal data

By signing up as a Group member, you agree to provide OnSide with certain personal information, which we will process in accordance with all applicable data protection laws to:

• provide you with services and carry out administration in relation to your membership;
• communicate with you and your parent / guardian about services and your membership, you can opt out at any time by contacting us; and
• provide information about your membership to OnSide (registered charity number 1125893), suppliers, funders and/or sponsors as required for the purposes of the development, coordination and support of the OnSide Youth Zone network. List available from enquiries@onsideyouthzones.org
  Your sensitive personal data

  We may collect sensitive personal information for example, information relating to your health, disability and/or ethnic background.

  I agree that my sensitive personal information can be processed to provide me with services and carry out administration in relation to my membership;

  I agree that my sensitive personal information may be shared with relevant Youth Zones in the network, suppliers, funders and/or sponsors (as required for the purposes of the development, coordination and support of the Youth Zone network). List available from enquiries@onsideyouthzones.org. OnSide Youth Zones will ensure that third parties agree to keep this information confidential.

  Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

  For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy

  Your image

  I agree to my photo and/or video being used:

• in printed marketing materials (e.g. a leaflet to promote OnSide or my local Youth Zone);
• on the OnSide or Youth Zone website or social media sites;
• in the media (e.g. to promote OnSide or local Youth Zone in a newspaper or on TV);
• in our printed or online advertising;
• by other organisations that want to promote OnSide and the Youth Zone’s work (e.g. schools, colleges, funding bodies and private sector organisations)
•  

  While OnSide makes every effort to ensure all media coverage is positive, OnSide does not have final control over how a journalist may portray you.

  Parent / guardian agreement for under 16s

  I confirm that I am the parent/guardian named in Emergency Contact 1 above and:

  
  I agree to use of the member’s information as above;

  I consent to any emergency medical treatment necessary, and authorise staff to sign any written form of consent required by the hospital authorities if the delay in getting parent/guardian agreement is considered by the doctor to endanger the young person’s health and safety;

  I would like to receive further information about Youth Zone services, events and support opportunities by email, phone, SMS, post or other means. You can change your mind at any time by contacting us.