East Side Youth Centre Registration Form

Details of young person

First name(*)
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Surname(*)
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Date of birth(*)
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Email(*)
Please use your parent or guardian's email address if you do not have one yourself.

Mobile
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School attended(*)
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Gender(*)
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Ethnic background (because the council needs to know)(*)
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Please give details of any health issues, special needs or disabilities that we need to be aware of. Include any allergies
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Details of parent/guardian

Name of parent or guardian(*)
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Address(*)
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Postcode(*)
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Email(*)
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Confirm email address(*)
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Telephone(*)
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Mobile
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Declaration by young person

I have read and agree to the Youth Club Rules.

(*)
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Declaration by parent/guardian

I have read and agree to the Parental Consent.

(*)
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What's on

Whats on

esyc

Club Sessions (Term Time only)

Entry £1 per session

Wednesdays

6.30 to 8.30 pm
Years 5, 6 and 7

Fridays

7.30 to 9.30 pm
Includes football and more in Sports Hall
Years 7 to 13.
Supported by local churches