Parental Consent Membership Form

(To be completed for all under 18's by the their parent/guardian/carer)

*Please note that if you wish for us to no longer store your data, please email this request to contact@aptitude.org.uk

www.aptitude.org.uk

Social Media: @aptitudeyouth

Identity

Young Person's First Name

Young Person's Last Name

Is there another name the young person goes by?

Young Person's Date Of Birth

Demographic

Young Person's Gender

Young Person's Ethnicity

Social Worker or Early Help

Address

Young Person's School/College (if not in school, type NONE)

Young Person's Address 1

Young Person's Address 2

Young Person's Town

Young Person's Post Code

Ward

Contact

Parent Contact Number

Parent Email

Parents name

If known, young person's contact number

Medical

Please tell us about any illnesses, allergies, disabilities, learning difficulties or other medical information here:

Permssions

If your child gets injured during our sessions, do we have your permission to administer First Aid?

For some of our projects, we may coordinate travel for young people. Do you give permission for your child to travel, unsupervised (e.g. in a taxi alone) as well as supervised (e.g. with at least two Youth Workers)?

I have read, understood, and accepted the privacy policy and other polices: www.aptitude.org.uk/policies.

Do you give Aptitude Organisation CIC full permission to use images of my child during youth activities, the use of these images from photographs/video filming, for promotion and fundraising online.

Activities

Activities your child will be attending:

Aptitude Youth Work - Consent Form