YMCA Barnsley

What We Do
What’s On
- Activities
- Youth Clubs
News
Sports Hall & Room Hire
Contact
Other

Donate

Consent Form

Please ensure you have submitted a consent form for each attendee prior to booking an activity, or your booking will be cancelled.

Details

Are you booking an Activity or a Club?(Required)

School Holidays Activities

Regular Weekly Youth Club

School Holidays Activity Name(s)(Required)

Please list all of the activities you are booking, separated by /

View Youth Club Information

Youth Club Name(Required)

Short Breaks (SEN)

Kendray & Worsbrough Family Centre

Y Stay In (13-19)

Juniors (8 - 12)

Little Y (5-8)

St. Johns Dodworth (8-12)

Other YMCA Provision your child attends/has attended

Participant Details

Participant Name(Required)

First Last

Participant Nickname

Participant Age(Required)

Participant Date of Birth(Required)

Day

Month

Year

Patricipant Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Participant School(Required)

Participant Ethnicity(Required)

Participant Gender(Required)

Participant Preferred Pronouns

Additional Information

Does your child have any of the following

Special Educational Needs

Educational Health Care Plan (EHCP)

Early Health Assessment (EHA)

Social, Emotional & Mental Health Needs

Autism Spectrum Disorder

Disability

EAL - English as a second language

Looked After Young Person

Other

Please note details of the above and include details of any additional needs, conditions, behaviours or triggers or care details that we should be aware of

Medical, Allergies & Dietary Details

Does your child suffer from any conditions requiring medical treatment, medication or have complex health needs? Please provide details.

Is your child Epileptic? If YES, tell us about their seizures and explain how they are managed

Does your child have any Allergies or Dietary requirements?

Travel Arrangements

My child will be collected by a parent or guardian from sessions(Required)

Yes

No

My child has permission to walk home from sessions(Required)

Yes

No

Parent/Guardian Contact Details

Parent/Guardian Name(Required)

First Last

Parent/Guardian Address(Required)

Street Address Address Line 2 City ZIP / Postal Code

Parent/Guardian Relationship(Required)

Parent/Guardian Mobile(Required)

Parent / Guardian Landline Phone Number

Parent/Guardian Email

Used for information on this and future events

Emergency Contact

If I am not available in an emergency, please contact:

First Emergency Contact Name(Required)

First Emergency Contact Telephone Number(Required)

Second Emergency Contact Name

Second Emergency Contact Telephone Number

Photography/Videography

This form allows you to give permission to YMCA Barnsley to take, retain and use images (still and video) for a young person attending YMCA Barnsley for use in YMCA Barnsley communications. Images may be made available to parents/carers of participants.

Are you content for photographs and video footage to be taken of your child to be used for the following promotional use?

Internal Displays(Required)

Yes

No

Social Media/Websites, External Publications, Funders Reports, Local newspaper and TV press etc.(Required)

Yes

No

Online & Virtual Meeting Consent(Required)

Yes

No

I understand the following Photography/Video terms(Required)

I agree to my image or that of my child may be stored and used by YMCA Barnsley and third party organisations to promote YMCA through various printed and digital communications and my data may only be used for legitimate promotional purposes.

My right to request that the YMCA Barnsley stop using my or my child’s image in future publications at any time by contacting: [email protected]

That the YMCA Barnsley will retain copyright, can edit images at its sole discretion, and I will not be paid a fee in respect of any use made of images.

That the images will enter in the public domain and therefore could potentially be reproduced by anyone in the world outside the control of YMCA Barnsley.

I understand the following Photography/Video terms

Emails & Surveys - Upshot Systems CIC

We sometimes use our data management system (Upshot) to send out emails & surveys.

I am happy to receive emails from YMCA Barnsley(Required)

Yes

No

I am happy to receive surveys from YMCA Barnsley(Required)

Yes

No

Data Consent

By submitting this form, I consent to YMCA Barnsley collecting and using my personal data and/ or the personal data of my child under the age of 16.

I Understand the Data Consent Terms(Required)

My personal details will be used by YMCA Barnsley to carry out their work and keep members, volunteers and employee’s connected with YMCA Barnsley safe.

My email, phone/mobile number and postal address may also be used by YMCA Barnsley to contact me with relevant information for any projects, consultations and campaigns in the future.

That any personal information that I provide to YMCA Barnsley will be stored securely and I have full access to YMCA Barnsley’s Privacy Policy on the YMCA Barnsley website.

That I am able to opt out of marketing and promotional activities associated with YMCA Barnsley and ask for my data to be deleted at any time by emailing [email protected] with this request.

I Understand the Data Consent Terms

Association with YMCA Barnsley (please specify):(Required)

Participant (Over 16)

Parent / Guardian of Participant (Child under 16)

Childs Name (if under 16)

Consent Declaration

I give consent for my son or daughter to take part in YMCA Barnsley activities. I agree to my son/daughter receiving emergency medical treatment, including anaesthetic, as may be considered necessary by the medical authorities present. I understand that the staff at YMCA Barnsley will not administer non-prescribed medicines.

NOTE: Should your child suffer any loss or damage to property or suffer any injury, a claim can only be made on his/her behalf against the party who has been negligent or in breach of some statutory duty. Whilst YMCA Barnsley organisers will take all reasonable steps to secure the safety of your child whilst in their care, they will only be liable if YMCA Barnsley, its servants or agents have been negligent or in breach of some statutory duty towards him or her.

Signature

Todays Date(Required)

Day

Month

Year

About

YMCA Barnsley
YMCA Barnsley YouTube Channel
YMCA England & Wales
Ethos, Vision, Values & Aims
Safeguarding
Partnerships
History
Privacy Policy
Sports Hall & Room Hire
Consent Form
Youth Club Enquiry Form

Get Involved

Get involved
Donate
Contact Us & Directions

Stay In Touch

Find us

YMCA Barnsley
1 Blucher Street
Barnsley, South Yorkshire
S70 1AP. Located in Barnsley town centre, South Yorkshire we are a five-minute drive from Junction 37 of the M1. Once here you will find street parking around our facilities or several larger car parks nearby. For those travelling via public transport we are a few minutes’ walk from the Barnsley bus interchange and train station.

Registered No: 97905
Charity No: 250190

YMCA enables people to develop their full potential in mind, body and spirit. Inspired by, and faithful to, our Christian values, we create supportive, inclusive and energising communities, where young people can truly belong, contribute and thrive.

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Cookie settings ACCEPT

Privacy & Cookies Policy

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience.

Necessary

Always Enabled

Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.

Non-necessary

Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.

SAVE & ACCEPT