Youth Club Registration Form

Youth Club registration form.

Please complete this form to allow you to be come a member of our youth clubs and be part of ongoing activities throughout 2026-2027. This includes main activities happening within youth club space however there may be times weather permitting where we may go on local visits i.e local park. Your parent/guardian will also be issued a consent form to give permission for being involved in wider activities/visits.

We will take photos throughout the year during different activities/events. This will be used for our reporting, social media promotion and service promotion. If you wish to not be included in these photographs, please be sure to let a member of staff know at your clubs. Otherwise we will accept that you are happy for you/your child to be included in photos.

The information you have supplied above will be used solely for the registration of you in the specific event you have detailed. We require this information to register you and to ensure your safety at the event. Without this information we are unable to allow you to participate in the event. The information will be processed and held securely in terms of Data Protection Legislation. For further information on our legal basis for processing your information and your rights in terms of Data Protection Legislation please visit www.Ayrshire360.com to view our Privacy Statement.

What Youth Club are you attending?

Kilmaurs Youth Club

Fenwick Youth Club

Newmilns Youth Club

Stewarton Youth Club

Name: *

* required

Maximum 255 characters

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What name you want to be known as: *

* required

Maximum 255 characters

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Date of Birth

Maximum 255 characters

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Address: *

* required

Maximum 5,000 characters

0/5,000

Phone number:

Maximum 255 characters

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Gender *

* required

Male

Female

Prefer not to say

Other (please specify)

What School are you from?

Maximum 255 characters

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Participant Email address

Maximum 255 characters

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10.

Relation to you: *

* required

Maximum 255 characters

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11.

Emergency Contact 1 Name: *

* required

Maximum 255 characters

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12.

Emergency Contact 1 phone number:

Maximum 255 characters

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13.

Emergency Contact email address

Maximum 255 characters

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14.

Do they live at the same address as you? If no, please give their address:

Yes, as above

No, their address is:

15.

Emergency Contact 2 Name:

Maximum 255 characters

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16.

Relation to you:

Maximum 255 characters

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17.

Emergency Contact 2 phone number:

Maximum 255 characters

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18.

Do they live at the same address as you? If no, please give their address:

Yes, as above

No, their address is:

19.

Do you have any illnesses, disabilities or allergies that may affect you when taking part in the activity/event? If yes, please provide further details.

Maximum 5,000 characters

0/5,000

20.

Do you take any medication that we should be aware of? If so, please state what medication, for what condition and if this is self-administered.

Maximum 255 characters

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21.

Please tick if you fall under any of the following categories:

Minority Ethnic

Family with a disabled adult or child

Family with three of more children

Family with a child under age of 1.

Young Carers

Care experienced

None of the above

LGBT+

Homeschool / Not in full time education/training

Other (please specify)

22.

I agree to myself/child taking part in the youth club receiving medical treatment, including anesthetic, as considered bu medical authorities present. I understand the extent and limitations of insurance covered.

YES

Option 3

23.

I agree to myself/child taking part in youth club agree to their participation in any or all activities described above. I acknowledge the need for respect and responsible behaviour on their part. I will advise if there are any amendments to the medical info throughout the year.

YES

24.

I agree to sign here providing information above is accurate. Formal consent forms will be issued to parent/guardians ahead of arranged trips/activities.

Maximum 255 characters

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