123 Anerley Youth Club | What's on | Crystal Palace Community Trust

Young Person's Forename

Young Person's Surname

Also known As

Young Person's Date of Birth

Young Person's Gender

Male

Female

Transsexual Female

Transsexual Male

Non-binary

Prefer not to say

Unknown

Prefer to self-describe

If you prefer to self describe, please specify:

How would you describe your young person's ethnic status

Disability/ Special need

Yes

Prefer not to say

Unknown

If yes, please give details below

Please be aware that it is crucial to fully disclose any additional needs your child may have, as failure to do so may impact their eligibility for a place in our program. However, if your child's needs exceed what we can provide, we will refer you to appropriate organisations that specialise in supporting children with more complex requirements.

Address Line 1

Address Line 2

Town/city

Postcode

Parent/Carer Mobile number

Parent/Carer Email

Name of school attended

Emergency contact: name

Emergency contact: phone no.

Emergency contact: relationship to young person

Is your young person a clarion resident?

Yes

Don't know

Does your young person get free school meals?

Yes

Prefer not to say

Does your young person have any Dietary requirements, Allergies or Medical Conditions?

Yes

If yes, please give details:

I understand that during activities run by the CPCT or within Anerley Town Hall photographs and videos may be taken of me/my child for promotional purposes. I give permission for these to be used in social media and hard copy promotional materials. (Tick to indicate yes)

Please add me to our Youth WhatsApp group with the main parent/carer phone number above

Do you wish to be on our youth mailing list? (Tick to indicate yes)

I understand that my child must abide by the rules. Failure to abide by them may result in temporary or permanent exclusion. (Tick to indicate yes)