HAF Knowsley 2023
HAF Registration form Knowsley
Young Person's Details
Young Person's Forename
Young Person's Surname
Young Person's Date of Birth
Address 1
Post Code
Name of school
Demographic
Gender
Please choose a value
Female
Male
Non-Binary
Do you have a disability? Please select all that apply
Sensory Impairment
Physical Impairment
Learning Disability or Cognitive Impairment
Mental Health Condition
Long-standing illness or health condition
Other
N/A
If other, please specify
Medication
Do you take any medication?
Please choose a value
Yes
No
If yes, please give detail
Emergency Contact
Full Name of parent/carer/guardian
Email of Parent/Carer/Guardian
Mobile
Free School Meal Eligible, self declaration
Free School Meal Eligability
Please choose a value
No, this young person is not eligible for Free School Meals
Yes, this young person is Free School Meal Eligible
Consent
Consent for Filming and Photography
I have parental/guardian responsibility for and give my consent for the images and/or case study of the child named above to be used in any of the following:
• Websites - use on Vibe website
• Websites - use on external/partner websites
• Publications – use in regional or national media or Vibe promotional material.
• Radio Interviews – to be broadcast on regional or national radio.
• Filming – to be show inside or outside of Vibe, including regional or national television.
I understand that if I wish this consent to be withdrawn I should contact the Marketing and Communications Team in writing via hello@vibeuk.org and they will remove my images and any information about me from their records. However, I understand that the material to be produced today is intended for public circulation and/or for publication in the mass media therefore withdrawal of content which has already been circulated publically may not be possible.
Where photographers and filmmakers are involved from outside of Vibe I understand that Vibe has no control over how these images may be used by external parties/media in the future. I accept the conditions of this agreement:
Yes
No
Full name of person providing consent
E-mail for person providing consent:
Clear
Consent to attend Vibe Activities
By ticking this box you agree you have parental/guardian responsibility for the above-named child and agree that they can take part in the above activities.
Vibe activities are supervised by qualified youth workers, However, accidents can happen. Vibe can accept no liability for injuries sustained or any other loss, howsoever caused, in the absence of the negligence of Vibe or its
employees.
Yes
No
Full name of person providing consent
Relationship to Participant
Parent
E-mail for person providing consent:
Clear
Submit
Please confirm the following details are correct
×
Free School Meal Eligible, self declaration
Free School Meal Eligability