Young Person Emergency Contact Form Please complete this form for every young person that is going to attend one of The Door's Youth Clubs. * Email Address Please provide a valid address. Details of Young Person This form should be completed by a young person aged 13 or over or by their legal guardian. * Full Name of Young Person * Date of Birth Sex Male Female Other Ethnicity/Nationality White British White Gypsy or Irish Traveller White European White Other Black British Black African Black Caribbean Black Other Asian British Asian Indian Asian Pakistani Asian Bangladeshi Asian Chinese Asian Other White and Black Caribbean White and Black African White and Asian Arab Other Mixed or Multiple Race Background School / College * Address * Post Code Emergency Contact Details These details will be used to keep you safe. Full Name of Parent (Or person with Parental Responsibility) * Relationship to young person - eg. Mum, Dad, Aunty etc Address if different from above Postcode * Emergency Phone Number: Mobile Emergency Phone Number: Home Emergency Phone Number: Work or Other Health and Wellbeing If you have any allergies/dietary requirements, ongoing medical requirements, disabilities or impairments please provide details in this box. Where did you find out about The Door's Youth Clubs? Photo Consent (Optional) I give my consent for photos and videos of the young person named above to be taken by The Door whilst participating in The Door’s activities, and for The Door to use these photos/videos in their fundraising and publicity. * GDPR Consent (Required to submit form) I consent to The Door storing and processing my personal information for use in connection with my safety or the safety of others. I understand that it may also be used on anonymised basis for the purposes of monitoring and improving The Door’s services. *
