Membership Form

Woodstock Youth Club


Youth Group: Woodstock Youth Club: 8year olds and over welcome

Opening times: Tuesdays Night 6pm until 8:30pm

Admission Charge: £1 a week

So that the youth group can provide a wide range of opportunities that reflects the membership, please list in the box below some of the activities that you are interested in:


We would be grateful if you could complete and return this form. The information given will help us to keep in touch with you and provide the best possible care for your son/daughter during our normal youth group sessions. All of the information on this form will be held and used in accordance with the Data Protection Act 1998.

Name of Young Person:

Home Address:

Mobile Number

Date of Birth:

Home Tel. No.:

Parent/Guardian’s Tel. No.:




Email Parent/ Guardian………………………………………………….Member……………………………………

Does your son/daughter have any health problems, medical conditions or allergies etc. (e.g. asthma, diabetes, epilepsy)? If yes, please give details below:


Do any of these conditions require special medical treatment, including regular medication? If yes, please give details below:


We would appreciate alternative contact details (in case of emergency).


Relationship to

Young Person (e.g. aunt):


Telephone No.:

Please give any other information you think may be useful:




To be signed only by a parent or other adult with parental responsibility

By signing this form I apply for my son/daughter to become a member of the youth group and acknowledge that they will become a member on receipt of this form.


I give permission for my son/daughter to take part in the normal weekly activities. I understand that the group leader and other workers, while taking all reasonable care in looking after my son/daughter, cannot necessarily be held responsible for any loss, damage or injury suffered by my son/daughter during, or as a result of, the group’s activities or if your son/daughter leaves the premises within club time, without permission of a youth leader or parent.


In an emergency, if I cannot be contacted despite all reasonable attempts to do so, I give permission for my son/daughter to undergo emergency medical/dental treatment including the use of anaesthetics as considered necessary and administered by suitably qualified medical practitioners.

Signature of parent/guardian: ______________________________ Date: _________________


Please can you indicate if you are happy for you son/daughter to walk home at any point of the evening unaccompanied?

I hereby give permission for my son/daughter to walk home unaccompanied.

Signature of parent/guardian: ______________________________ Date: _________________