Please use this form to register your interest in activities at Bruce Grove Youth Centre.Your details Full name * Address line 1 * Address line 2 City Postcode Phone number * Email * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011 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 Email Status * Parent Guardian Emergency contact Is this your parent/guardian? * Yes No If not, please enter emergency contact name and number here Activities Choose which activities you are interested in from the list below: Activities available Archery and fitness Artist development Arts and crafts Badminton Bike maintenance Boxing and fitness Clothes and T-shirt making Cooking Customise your own t-shirts, clothes and bags Fashion design Film making Football training - non contact Gardening Group coaching Hopeville Entrepreneurship Jewelry making Lawn tennis Love me natural (hair) Movies Music Pebble arts Photography Pocket money Podcasting Prosthetic filming Prototype mobile and building websites Recycling crafts Robo car building Sanjuro (martial Arts) Sexual health Table tennis Vocal lessons Yoga Confirmation You need to read and agree to the following policies before submitting this form:Membership PolicyTo help us plan and promote activities, everyone using Youth Space needs to have taken out a membershipPlease help to make the centre an enjoyable place by showing all centre users and staff equal levels of respectSecurity PolicyThe centre is a substance-free environment, please do not bring drugs and alcohol or prohibitedBags 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 searchedSafety PolicyAll participants will be asked to ensure that they use hand hygiene throughout the day while at the centreAnyone who is feeling unwell, or experiencing COVID-19 symptoms, should stay home and self-isolateIf you arrive – or become – unwell, you will be sent homePlease respect the on-site social distancing measuresNotesPlease 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