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Lewisham Youth Service Membership Form 2025/2026

Thank you for registering for Lewisham Youth Services for children and young people aged 8-19 (up to 25 years for those with Special Educational Needs.) Please note that this form must be completed by an adult over 18 years who holds parental responsibility.

If you have any issues or queries, please contact LewishamYouthServices@Lewisham.gov.uk

Identity

Forename

Surname

Date Of Birth

To which gender do they most identify?

Is your gender the same that they were assigned at birth?

Address

Address 1

Address 2

Town

County

Post Code

Contact

Young Person's Mobile

Young Person's Email

Demographic

Which of the following best represents the young person's ethnicity?

School Information

Is your child/dependant eligible to receive income based free school meals?

If the young person is under 16, are they currently in school, college or home-school? (Please tick and name school)

School/College Name or Home Educated

If the young person is over 16, are they currently in education, employment or training? (Please tick and give details)

Additional Information

Is the young person? (please tick all that apply). This information is optional and will be treated confidentially.

Looked after by the Local Authority Already working with any agencies A young carer

Please give details

Please select the Site child would like to attend

Parent/Carer/Guardians Details (First Emergency Contact)

Forename

Surname

Relationship to Young Person

Contact Number

Address

Postcode

Second Emergency Contact ( Must be different from First Emergency Contact )

EC2 - Name

EC2 - Relationship to Young Person

EC2 - Contact Number

Consent Information

Photographic/Media Consent- Basic (We take images of people who participate in our programmes to use in our centres, in print, online, social media, in reporting to funding and for other marketing purposes. We comply with privacy regulations.)

Consent for One-to-One support programme (We offer a 121 support service for young people to have dedicated support sessions with a One-to-One Practitioner. Young people can self-refer or be referred by a Youth Worker of professional to sessions.)

Consent to visit another site (Consent to visit other sites with a member of staff without seeking additional permission.)

Consent to use Climbing Wall (For the young person to use the climbing wall alongside a trained instructor.)

Lewisham Youth Service Membership Form 2025/2026

Thank you for registering for Lewisham Youth Services for children and young people aged 8-19 (up to 25 years for those with Special Educational Needs.) Please note that this form must be completed by an adult over 18 years who holds parental responsibility.

If you have any issues or queries, please contact LewishamYouthServices@Lewisham.gov.uk

Identity

Address

Contact

Medical

Demographic

School Information

Additional Information

Parent/Carer/Guardians Details (First Emergency Contact)

Second Emergency Contact ( Must be different from First Emergency Contact )

Consent Information

Data & Medical Consent

Lewisham Youth Service Membership Form 2025/2026

Identity

Address

Contact

Medical

Demographic

School Information

Additional Information

Parent/Carer/Guardians Details (First Emergency Contact)

Second Emergency Contact ( Must be different from First Emergency Contact )

Consent Information

Data & Medical Consent

Please confirm the following details are correct

Identity

Address

Medical

Parent/Carer/Guardians Details (First Emergency Contact)