Youth Club Registration FormPlease complete and submit this form and we will get back to you soon. Date of first session Name of Child * First Name Last Name Date of birth School Address Address 1 Address 2 City State/Province Zip/Postal Code Country Telephone Email * Gender Male Female Ethnic Origin Why do you want to join our youth club? How did you hear about it? Direct email Library Flyer at School Friend Community centre Other If you selected community centre or other, where did you hear about us? Did you participate in any other Thanet Projects? If so, which? In case of emergency, contact details for parent/guardian Name and Telephone number Does the participant suffer from any medical conditions? * Yes No If you answered yes, please provide details. Does the participant suffer from any food allergies? Yes No If you have answered yes, please provide details Parental consent for photographic/film use of children under 16 years of age * I, being the child/children’s parent or legal guardian, give permission for The Thanet Youth and Community Centre (The Thanet)’s youth club, based at Malden hall, Herbert Street, London NW5 4HD to take and use publicity photographs/film of the child named in this form. I acknowledge that still or video images of the child may be used on The Thanet’s website www.thethanet.com where they may be viewed by the public. I also consent to use of the photos for publicity and marketing The Thanet Youth Club. I agree that the photos/film may be combined with other images, text and graphics and be cropped, altered or modified in any way which The Thanet deems appropriate. I consent to the provision of this form and the details within it to The Thanet, and to their storing these on a database. I understand that the child’s name will not be given to press or public without my consent. I also understand that I may cancel this permission in writing, and that if I do so The Thanet will take all reasonable steps to ensure that the photograph/film is withdrawn from future use. I further understand that I shall receive no payment for this assistance. I agree I do not agree Thank you!
