Attendee sign-up

First name *

Last name *

Nickname

Gender *

Date of Birth e.g. 26/05/2001

I am 16 or over

Contact relationship type You are stating that you are the adult responsible for this young person and give your consent to be registered on Upshot (which includes permission to attend sessions).

Contact first name

Contact last name

Address line 1

Address line 2

Address line 3

Town/City

County

Postcode

Mobile phone

Other telephone number

Emergency contact details * Please provide the name and phone number (ideally mobile) for at least one emergency contact but preferably two

Please provide the most relevant e-mail address we can use to contact you or your son/daughter. Any e-mails sent will be directly relevant to the provision you or your son/daughter attends at Romsey Mill. This e-mail address will not be used for general information about Romsey Mill and will not be passed on to partner organisations.

Contact email address *

Specific medical conditions

Any other conditions, allergies or dietary requirements, etc.

Disability *

Ethnicity *

I give permission for the use of photos or other media featuring me.

I give permission to receive emails from Romsey Mill - Youth Development Team via Upshot

Is happy to receive surveys via Upshot

Consent A (Participation) * I give consent for me/my child to participate in all Romsey Mill activities (virtual or in-person) with the exception of trips/residentials for which specific consent will be requested. I recognise that all due care & responsibility will be taken for my/my child’s welfare but that Romsey Mill cannot be held responsible for any loss/injury suffered by me/my child. Should the need arise, I agree for me/my son/daughter receiving emergency medical treatment, including anaesthetic, considered necessary by medical authorities present. I understand that Romsey Mill is covered in the event of accidents caused by their negligence but does not provide personal insurance for participants

Consent C (Transport) * I give consent for my child to be transported by Romsey Mill team members (including approved volunteers) for the purpose of Romsey Mill activities

Consent D (Social Media) * I give consent for Romsey Mill to connect to my child through professional social media accounts including, but not limited to, Facebook, Twitter & Instagram

Consent E (Freedom to leave) * I am aware that Romsey Mill are unable to keep a child in an activity against their will

Consent F (Information Sharing) * I give consent for Romsey Mill to share relevant information about me/my child with other organisations who are already involved in my/my child's welfare (e.g. school) for the purpose of improving the quality of support offered to me/my child

Confirmation: By submitting this form I am confirming that I am either the young person named above (and over the age of 18) or the legal parent/guardian of the named young person and that the information given is, to the best of my knowledge, accurate.

Data privacy notice: Romsey Mill is committed to compliance with the General Data Protection Regulation (GDPR), which came into force on 25th May 2018. The personal details which you provide about yourself & your son/daughter & which we store may be used for: Informing you or our staff of issues relating to your son/daughter (i.e. to contact you in the event of an emergency); ensure the safety & wellbeing of your son/daughter during their time with us; informing you of issues relating to our work in general; providing statistics to funders & statutory bodies.
We will not disclose any of the personal information you provide to a third party without your consent unless we are legally required to do so. We are legally obliged, upon request, to provide you with all the information we hold about you or your son/daughter. You are entitled to request further information from us on how we use & store data about you and your son/daughter.

I accept the organisation's Terms & Conditions and Privacy Policy *

Finally, please confirm you are a real person. *

Sign up with Romsey Mill - Youth Development Team

Basic details (of young person)

Contact details (of young person)

Correspondence details

Medical details

Equalities details

Permissions

Confirmation

Terms & Conditions and Privacy Policy