Young Leaders Programme | What's on | Crystal Palace Community Trust

Young Person's Forename

Young Person's Surname

Also known As

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

Does your young person have a disability/ special need?

Yes

Prefer not to say

Unknown

If yes, please give details below

Please note that it is important that your child’s needs are clearly explained, to ensure that we have the correct staffing and resources to support them and keep them safe. Our venue is safe and trained staff provide high levels of supervision; however, the session may not be suitable for children with Special Educational Needs and/or Disabilities (SEND). Bromley’s HAF Team works closely with our services and partners that offer provision for children and young people with more complex needs. If the needs of your child exceed what we can safely offer in our provision, we will refer you to Bromley’s HAF Team who will signpost you to other activities and services available that could meet the needs of your child.

Parent/Carer's Telephone number

Parent/Carer's Mobile number

Parent/Carer's Email

Emergency contact: relationship

Do you have any Dietary requirements, Allergies or Medical Conditions?

Yes

Address

Name of school attended if applicable

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

Do you wish to be added to the CPCT Parent WhatsApp Group chat? (Tick to indicate yes)

I understand that I/ my child must abide by the rules appropriate to the service/activity they are attending. Failure to abide by them may result in temporary or permanent exclusion. (Tick to indicate yes)