Blackburn Youth Zone is now offering FREE membership when you use the code JULYFREE

Get Stuck In Booking Request

Childs Name

Childs D.O.B

Childs Address and Post Code

Childs Age as of 3rd August

Gender
MaleFemalePrefer not to say

Parent/Guardian Name

Contact Number 1

Contact Number 2

Email Address

Does This Person Have Parental Responsibility?

Your child 8-12 years is interested in ‘Get Stuck In’ Activity Day:
I would like activity packs & lunchtime food deliveryI would like to access activities digitallyI would like courtesy and engagement callsI am interested in my child attending Youth Service

Your child 13-16 years is interested in:
MusicSport & activity (those approved inline with government guidelines)RecreationalLearning & projectCreative artsMeeting friendsOther, please specify

Which weeks would you like to book your child in (subject to availability):
w/c 03.08.2020w/c 10.08.2020w/c 17.08.2020w/c 24.08.2020

My child is already a BYZ member
YesNo

Does your child receive a free school meal or have you recently applied for FSM?
YesNo

Do you authorise the taking and distribution of images of your child in relation to the Get Stuck In project
YesNo

Does your child have any additional or special needs?
YesNo

Does your child have any dietary requirements?
YesNo

Does your child have any allergies?
YesNo

Please keep me updated on Blackburn Youth Zone news and updates by email, post, SMS, phone or other electronic means. Blackburn Youth Zone will always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes.
YesNo

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