Registration form

Your details

Full name *

Address line 1 *

Address line 2

City

Postcode

Phone number *

Email *

Date of birth *

Day

Month

Year

Gender

Ethnicity

Health information *

Please indicate any medical condition you may have (e.g. asthma, epilepsy, etc.) and any medication that may be required. You are responsible for informing the youth practitioners of any changes to this medical information as soon as possible.

Education/work

School/college attended

Course/level

Place of work

Parent/Guardian details

Full name *

Address (if different)

Home phone number

Work phone number

Mobile number

Status *

Parent

Guardian

Emergency contact

Is this your parent/guardian? *

Yes

If not, please enter emergency contact name and number here

Confirmation

You need to read and agree to the following policies before submitting this form:

Membership Policy

To help us plan and promote activities, everyone using Youth Space needs to have taken out a membership
Please help to make the centre an enjoyable place by showing all centre users and staff equal levels of respect

Security Policy

The centre is a substance-free environment, please do not bring drugs and alcohol or prohibited
Bags should be left in the lockers available and only will be brought into the centre in exceptions circumstances. All bags brought into the centre will be searched

Safety Policy

All participants will be asked to ensure that they use hand hygiene throughout the day while at the centre
Anyone who is feeling unwell, or experiencing COVID-19 symptoms, should stay home and self-isolate
If you arrive – or become – unwell, you will be sent home
Please respect the on-site social distancing measures

Notes

Please co-operate if you are asked to leave the centre.
Refusal to leave may lead to the police being called.

Confirmation *

Yes I have read and accept the Centre's policies

Haringey Youth Space

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Haringey Youth Space