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Membership Form

DISTINGTON CLUB FOR YOUNG PEOPLE

APPLICATION FORM FOR CLUB MEMBERSHIP.

 

Club Behaviour Policy

  • Respect the youth workers / volunteers at the club and other club members at all times.
  • No alcohol, drugs and smoking allowed on the club premises.

(Smoking is only allowed for over 16’s away from the main hall, to comply with new smoking laws as from July 2007).

  • No one under the influence of alcohol or drugs allowed on the club premises.
  • No bullying or racial abuse of any kind is permitted.
  • Respect yourself and others.
  • Respect and look after your building/equipment. Due to equipment getting damaged on a regular basis we will have no option but to charge any young person seen damaging any equipment.
  • During certain club sessions the use of certain social networking sites (i.e. facebook, msn) will not be permitted

  

These rules are there to abide by, but this does not stop you enjoying yourself and having fun.

 

I…………………….. Having read these rules promise to abide by them. I am aware that if I do break any of the rules and/or the club regulations I can be punished by being suspended from the club for a set length of time as decided by the club management committee, with the ultimate punishment being banned from the club. (See notice board for rules)

 

Signed…………………………………………

Club Membership.

Members Name ………………………………….Membership No……………..

 

Weekly Subscription £1.00 payable on the first visit to the club each week Members Signature…………………………………….

 

Parents please turn over and fill in details requested

Parent or Guardians Declaration.

 

I have read and understand the rules and regulations of THE DISTINGTON CLUB FOR YOUNG PEOPLE and acknowledge that my son/daughter will be unable to attend or take part in any club activities if he/she does not abide by the rules set above

 

 

Signed………………………………….                    Date……………………

 

Please print the name and address and Date of Birth of your child

 

Name……………………………………………

 

Address…………………………………………………………………………………..

 

Postcode…………………………………………

 

Telephone Number……………………………..Mobile Number…………………………………

 

Date of Birth……………………………………

 

Contact Name and Address and Telephone Number (in case of Emergency).

 

Name……………………………………………..

 

Address……………………………………………………………………………………………………………………

 

Telephone Number……………………………….Mobile Number …………………………………

 

Any medical problems you would like us to be aware of:

 

…………………………………………………………………………

 

…………………………………………………………………………

 

 

 

PERMISSION TO USE PHOTOGRAPHS

We require consent for their photo to be used in a presentation board/reports and newspaper articles to promote youth work in your area. The image(s) will not be used or copied for any other purpose.

I GIVE CONSENT FOR PHOTOGRAPHS TO BE USED FOR PUBLICITY.

 

Signed: _____________________________

(Person with parental responsibility)

 

 

SHARING INFORMATION 

We also require consent for contact details and information to be securely stored at Distington club for young people for use in statistical monitoring and may be shared with other agencies that include; Inspira, youth offending team, Cumbria County Council, Duke of Edinburgh Award Scheme; Youth Achievement Awards, Keyfund Federation and Young Cumbria  

 

I GIVE CONSENT FOR STATISTICAL INFORMATION TO BE SHARED

 

 

 

Signed: _____________________________

(Person with parental responsibility)