Child & young person registration form

Registration form for children and young people attending sessions at Scargill House

Date of Arrival*
Personal Details
Name*
First Last Likes to be known as
Address*
Street Address Address Line 2 City County Post Code Country
Contact name & number*
Parent's email address*
Gender
School Year in September 2022*
Date of Birth*
Age on Arrival*
Medical information/Allergies
Has your child ever suffered from any of the following?*
- My child does not have any medical conditions
- Epilepsy
- Cardiac or Respiratory problems
- Latex Allergy
- Asthma
- Migraines
- Diabetes
- Plaster Allergy
- Food Allergy
- Other
If yes please give details
Is your child currently taking any medication?
Please tick all that apply*
- My child is not currently taking any medication
- Insulin
- Epi Pen
- Inhaler
- Other
If you have answered yes to any of the above, please give details
Please tick to agree to the following statements
I understand that it is the responsibility of the parent / carer to administer any medication during the sessions.*
- Yes
I understand that I will be contacted if an accident should occur that requires more than basic first aid.*
- Yes
I am aware that a parent, carer or another named adult must remain on site for the duration of the creche, youth & children's sessions. Also, no young people under the age of 18 may be left on site unsupervised at any time.*
- Yes
If you cannot contact me directly in an emergency, I give full permission for my child or young person to receive treatment administered by a doctor, dentist, paramedic or other qualified person.*
- Yes
- No
Additional Needs
Please contact the Youth Team on 01756 760500 if you would like to discuss your child, or young person's needs directly
Does your child or young person have any additional needs including physical, learning difficulty, or a recent life change (including bereavement, separation, adoption etc) that we need to be aware of?*
- Yes
- No
In order to best meet the individual needs of a child or young person you are bringing to Scargill House, we would find it really helpful if you could discuss any additional needs a child has before visiting. That way the team can work together with you to see how we can include all children in what Scargill has to offer. We are committed to finding ways to make it work on a case by case basis. Unfortunately, we are unable to offer one to one care for any individual child. On occasions it may be necessary for an adult from your party to attend the youth and children's sessions with a child that has additional needs. We know that being a full time carer for a child with additional needs can be tiring, so please feel free to speak to us about funding to bring an extra adult along to help out.
If yes to the above please could you give further information here.
Appropriate Clothing
Please ensure that your child comes to sessions in clothing that could be worn outside - especially footwear. We will inform you in advance if we are planning to go up onto the estate, in which case, long trousers, suitable footwear and a waterproof coat are recommended. If your child requires sun cream or insect repellent please ensure you apply this before each session.
A Creche will run for one hour during the first adult session. This is for children who have not yet started Primary School.
Early years information (Complete for children under 5)
- My child wears a nappy
- My child is potty training
- I give permission for a member of the Scargill Youth Team to change my child's nappy, or to assist with toileting
- I would prefer if you came & found me to deal with any of my child's toilet needs
Collection at the end of each session
I understand that, if my children have not yet started secondary school, it is my responsibility to bring them to sessions and meet them in the Sun Lounge at the end of each session (at the time indicated on the programme)*
- Yes
My child is in Secondary school, and I am happy for them to leave at the end of each session, without being collected by an adult.
- Yes
- No
Out of Session Responsibilities
Creche runs 10.15-11.15, and the youth & children's sessions (5 - 17 yrs) from 10.00 - 11.15 & 11.45 - 12.30. I understand that children are the responsibility of their parent or guardian outside of the morning session times.*
- Yes
I understand that children who have not yet started Secondary school will need an adult with them to participate in out of session activities, including walks & workshops*
- Yes
Photograph Consent
Please choose all you are happy with*
- I give permission for a member of the Scargill Team to take photographs & videos of my child/young person for use only within house
- I give permission for photographs or videos taken of my child/young person by a member of the Scargill Team to be used in promotional & marketing material, such as presentations, display boards, & programmes to promote Scargill House
- I give permission for photographs & videos taken of my child/young person to be shared via Scargill's digital media sites, including our website & Facebook page
- I do not give permission for a member of the Scargill Team to take any photographs or videos of my child/young person
Your data will be processed securely by Scargill Movement. See our Child & Young Person Registration Form Privacy Notice.
Thank you for your cooperation. We look forward to welcoming you, your children, & young people very soon. Blessings from The Scargill Youth Team

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Child & young person registration form

Registration form for children and young people attending sessions at Scargill House

Personal Details

Medical information/Allergies

Is your child currently taking any medication?

Please tick to agree to the following statements

Additional Needs

Appropriate Clothing

A Creche will run for one hour during the first adult session. This is for children who have not yet started Primary School.

Collection at the end of each session

Out of Session Responsibilities

Photograph Consent

Thank you for your cooperation. We look forward to welcoming you, your children, & young people very soon. Blessings from The Scargill Youth Team