Youth Group Registration Form

Everyone who has booked into a Queen's Hall Youth Group must fill in this form to secure their place. A separate form is required for each participant.

Surname of child

First name of child

Date of birth

Does your child have any medical conditions, special requirements or access needs, that we should be aware of, including allergies and any medications taken at present? If so please give details including whether they can administer their own medication.

Is there anything else we may need to know about your child?

Surname of main parent/guardian

First name of the main parent/guardian

Address of main parent/guardian

Phone number of main parent/guardian

Email address of main parent/guardian

Name of second person for emergency contact

Contact number of second person for emergency

At the end of the session, do you require your child to be supervised until collected by yourself or another person authorised by you?

Yes
No

Permissions. I give permission for my child to be filmed, photographed and/or recorded. The recorded material may be used by Queen's Hall Arts for publications, newsletters, local/national/international press.

Yes
No

Consent for storing submitted data

Yes, I give permission to store and process my data