Registration Form
All About Young Person
Your Forename
Your Surname
Date Of Birth
Day
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
School
The Bay CE Secondary
The Bay CE Primary
Broadlea Primary
St Blasius CofE Primary Academy
Gatten & Lake Primary
The Island Free School
Lionheart School
Medina House School
St Catherine's School
St George's School
Isle of Wight College
HTP College
Other
Gender
Please Select
Male
Female
Non-Binary
Other
Prefer not to say
Preferred Pronouns
She / Her
He / Him
They / Them
Other
Phone Number (the number you'd like us to contact you on ie yours / parent / carer)
Email
Tell Us Where You Live
Address 1
Town
Post Code
A Minute for Medical
Disability
Please Select
Yes
No
Not Disclosed
Do you have any medical conditions or disabilities you think we might need to know about to best support you:
The "Just in Case' Adult
Name
Relationship to you
Phone Number
The "Backup" Adult
Name
Relationship to you
Phone Number
Small Print, Big Deal
We may wish to message you about upcoming events or activities. Are you happy for us to contact you by phone/ text?
Please Select
Yes
No
We may take photos/videos publicity and promotional purposes (including digital and print e.g. website, social media, advertising materials). Are you happy for your images to be used?
Please Select
Yes
No
Please be aware that all sessions are open access and as such children and young people can come and go freely. Parents/ carers will not be informed by Bay Youth Project staff if children or young people leave a session.
Please Select
Yes
Consent
Data Consent Statement
The information you have given us includes ‘sensitive personal data’ as defined under the Data Protection Act 2018. Community Action Isle of Wight is committed to your privacy. We will use the information on this form for the purposes of administrating the project. A copy of our privacy notice and our Data Protection Policy can be found by visiting - https://www.communityactionisleofwight.org.uk/our-policies/#13-28-safety-and-security
All staff and volunteers Community Action Isle of Wight are committed to safeguarding. If you tell us something that worries us, we may need to share this information with parents/ carers/ other agencies.
Yes
Full name of person providing consent
Relationship to Participant
Young Person (If 13 years or older)
Parent/Carer
Clear
Submit
