Youth GRC

15 Years

Join someone else

1
YOUR DETAILS
2
MEMBERSHIP DETAILS
e.g. Joe
e.g. Bloggs
We need this for exam entries and public performances.
'Nickname' or 'known as', if different to first name.
e.g. 21-Sep-1997
(e.g. South Oxfordshire, West Berkshire)
e.g. 01491 123 456
e.g. 07712 345 678
e.g. 0208 123 4567
The child's other parent/ step-parent/ guardian, who is the next person of contact.
If different to yours.
e.g. 07712 345 678
e.g. 0208 123 4567
e.g. 49 Stanley Lane, Woodcote, Reading
e.g. RG8 9FU
If different to yours.
In Case of Emergency (ICE)
Please provide contact information for a responsible adult other than yourself and the 2nd named parent/guardian who can take responsibility for your child in the event that we are unable to contact you, or you are unable to collect your child.

e.g. grandparent, family friend
This is the first number we will call. It can be home, mobile or work.
Health and Wellbeing
Medical conditions and allergies will not affect the involvement / inclusion of your child with any GreenRoomCollective activity. 
e.g. friends attending, recent or recurring injuries, particularly shy, etc.
Do you give permission for your child to travel (walk, cycle etc) home alone, or unsupervised by an adult?
Do you give GreenRoomCollective permission to use and reproduce any photographic or recorded image or likeness of your child, anonymously, for promotional purposes. All images are copyright of GreenRoomCollective. For further info see GRC Terms&Conditions
Confidentiality Declaration 
All information provided on this form will remain strictly confidential to GreenRoomCollective, its staff and authorised workshop leaders. It will not be shared with any third party other than for GreenRoomCollective administrative/ operational purposes' or  unless it is required by a member of the emergency services as the result of an accident, an evacuation of a building or other emergency.