wft-summersonic-online-form

Child / Young Person Full Name*

School/College:*

Date of Birth*

Age

Gender*

Male (including trans male)
Female (including trans female)
Gender Queer / Non-binary
Prefer not to say

Ethnicity*

Is the Child / Young Person entitled to free school meals?

Yes
No
Prefer Not To Say

Does the Child / Young Person have additional caring responsibilities at home? (For example Young Carer)

Yes
No
Prefer Not To Say

If yes please specify

Is the Child / Young Person LAC (Looked After Child for example in foster care or other)

Yes
No
Prefer Not To Say

Does the Child / Young Person consider themselves to have a Disability?*

Yes
No
Prefer Not To Say

Disability - If yes please specify

Does the Child / Young person have Medical conditions / allergies?*

Yes
No
Prefer Not To Say

Medical Conditions - If yes please specify

You are responsible for declaring any disabilities/medical conditions that could affect the Child / Young Persons participation otherwise we would be unable to make a fully informed risk assessment.*

tick to confirm have understood

Dietary requirements*

Food Allergies*

Address*

Post code*

Emergency Contact Name & Relationship To Child / Young Person*

Emergency Contact Number 1*

Emergency Contact Email*

Emergency Contact Name 2 & Relationship To Child / Young Person*

Emergency Contact Number 2*

GP name, contact number and surgery

I give my consent for WFT and Partners (including Wythenshawe Community Housing Group, members of Wythenshawe Youth & Play Alliance, Manchester City Council and Young Manchester) to copyright, reproduce, publish and otherwise use photographs and video footage of my child / young person for any purpose including advertising, publicity, trade and the WCHG partner websites. The image(s) may also be included in the WCHG image library for future use relevant to the above purposes. Your child / young person's contact details will remain strictly confidential.'**

Yes
No

(For under 11s) do you give permission for the Child / Young Person to walk home on their own?’

Yes
No

If you, or anyone in your family displays any symptoms of COVID-19 before attending a session, it is imperative that you do not attend and where possible inform your WFT contact as soon as possible. If you, or anyone in your family displays any symptoms of COVID-19 after attending a WFT session, it is vital that you inform your WFT Coach as soon as possible*

I acknowledge and understand the above

I understand that the information I have entered in this form is being collected by Wythenshawe Forum Trust and will be held by the lead delivery partner (WCHG) for the purposes of delivering these sessions safely and efficiently, and that the information may be shared with partners (including WFT, members of Wythenshawe Youth & Play Alliance, Manchester City Council and Young Manchester), but only to the extent necessary for delivering the activities and for reporting purposes. Any information that is shared with funders will be anonymous.**

I acknowledge and understand the above privacy notice

For further information read our privacy notice..

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WCHG Youth and Play Partnership – Wythenshawe Forum Trust (WFT) Summersonic sessions

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WCHG Youth and Play Partnership – Wythenshawe Forum Trust (WFT) Summersonic sessions

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