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Baytree Service Programmes

Youth Programmes

Identity

Forename

Surname

Date Of Birth

Address

Address 1

Address 2

Town

County

Post Code

Contact

Tel no:home

Mobile

Email

For the Youth Service Only: Contact details of -

Emergency contact details

Emergency Contact 1 - First Name

Emergency Contact 1 - Last Name

Emergency Contact 1 - Tel no: home

Emergency Contact 1 - Tel no: work

Emergency Contact 1 - Tel no: mobile

Emergency Contact 1 - Email

Emergency Contact 1 - Relationship

Emergency Contact 2 - First Name

Emergency Contact 2 - Last Name

Emergency Contact 2 - Tel no.

Emergency Contact 2 - Email

Emergency Contact 2 - Relationship

Child Collection

She will make her own way home

(1) Person, relationship and contact number of person authorised to collect your daughter

(2) Person, relationship and contact number of person authorised to collect your daughter

Notes:

Health and Safety

Specific requirements relevant to accessing our service:

Specific requirements relevant to accessing our service: Other mobility, temporary or otherwise (please specify)

Do you have a long-term health condition or disability

Physical condition or disability

Mental health conditions

Neurodevelopmental ' learning conditions

Any medical needs/allergies, special assistance, or any additional information for us to know?

Education

Youth: Education status

Year of school/college

Name of current school /college

Course studied

Country of previous education

Support

Do you receive free school meals/pupil premium?

Are you or anyone in your household unit receiving any benefits? (select all that apply)

Demographic

Sex

Civil Status

Religion

Nationality (select all that apply)

Country of birth

First Language

Any other languages (select all that apply)

Ethnicity

Immigration Status

What is your immigration status?

If you were not born here, when did you come to live in this country?

Household Unit

Do you have caring responsibilities? Please describe.

Looked after:

Number of adults in household (female)

Number of adults in household (male)

Number of children in household (female)

Number of children in household (males)

Housing Situation

Which best describes your housing situation?

Youth: Which best describes your living situation?

Why Baytree?

What attracted you to Baytree? (select all that apply)

Baytree Reach

How did you hear about Baytree? (select all that apply)

Does a family member attend activities at Baytree? (select all that apply)

Data Protection and Media Content

Our Data Protection Privacy statement explains how we look after your information and what we do with it — you can find a copy on our website or by asking a member of staff. When you sign up for or use any of our services, we will save the information you provide on our systems, which are accessible to all our staff. Generally, the information you provide us will be treated as confidential amongst our staff, however, in certain circumstances (for example, if we are concerned that you or others are at risk of harm) we may be need to disclose some information to third parties (including, for example, the social services). By accessing our services, you confirm that you consent to the storage and use of your data.

You agree to be contacted by the following methods:

Youth Service Registration Form