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Become a Member

To join the Blackburn Youth Zone members ‘family’ fill out the application form below then come down to the Youth Zone with the £3 membership fee and one form of identification such as a birth certificate or passport.

Home Phone:

Birthdate:
School/College/Employer:

Emergency Contact Name 1:

Emergency Contact Email 1:

Relationship Emergency Contact:

Emergency Contact Address 1:

Disability:

Additional Needs:

Medical Conditions:

Member Image Consent:

Parent Consent to Attend:

Member Agreement:

YouthZone: