Youth Voice Registration Form 2016-17
Young person’s name:
Region:
Local Authority:
All Youth Representatives attending British Youth Council (BYC) residential events, and their
parent/guardian, are required to complete this registration form.
Please be aware that it is a legal requirement for BYC to collect the details on this form before
young people can attend any events. Each Local Authority may also require the young people and
their parent/guardian to complete additional registration and/or consent forms for events for their
own insurance/legal requirements.
Scan and email to: [email protected]
Post: FAO: Declan Sharkey
British Youth Council
CAN Mezzanine,
49 – 51 East Road,
London
N1 6AH
If you require this form in larger print or have any questions please contact: [email protected] /
020 7250 8380
This registration form will be kept confidential in a locked secure location in our London Office.
Young Person
First Name: _________________ Surname: _________________
Date of Birth: _____________
Gender: _____________
Local Authority/Constituency: _____________________________________________________
School name: _________________________________________________________________
Home address:
_____________________________________________________________________
_____________________________________________________________________________
_________________________________________
Postcode: _________________________
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Home tel number: __________________________
Mobile number: _____________________
Email address (Please note that this will be used as the primary method of contact including to
send out information for any online referendums. Please ensure it is written clearly.):
Young Person’s Medical, Dietary and Access Requirements
Has the young person ever suffered from any medical conditions (for example asthma, fainting or
allergies)? Please give any details, severity of conditions and relevant medical information below.
Please use a separate sheet and secure it to this form if necessary.
Any religious needs: _____________________________________________________________
Does the young person have any dietary requirements that we need to be aware of? (e.g. Halal,
vegetarian, lactose intolerant) Please use a separate sheet and secure it to this form if necessary.
Does the young person have any access and/or communication requirements that we need to
be aware of? Please use a separate sheet and secure it to this form if necessary.
Consent for use of young person’s image, likeness, voice and contact details
Working with the press and media often forms an important and rewarding part of a youth
representatives’ term of office. BYC has an experienced press team who are available to support
young people with their dealings with the media and journalists. Media work can range from
interviews with newspapers, radio stations and television programmes, to promoting BYC at
events and on the website.
At events BYC will often take photographs of young people. We may use these images in our
organisation’s promotion, or in other printed publications that we produce, as well as on our web
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site. We may also make video or web cam recordings for project conferences,
monitoring or other educational use.
To comply with the Data Protection Act 1998, we need your permission before
we can photograph or make any recordings of your young person. Please
circle or underline yes or no to the following questions:
<< This section must be completed by the parent or guardian >>
May we use your young person’s photograph in BYC programmes and/or
other printed publications that we produce for promotional purposes?
Yes
No
May we use your young person’s image on our web sites and official social
media pages
Yes
No
May we record your young person’s image on video or web cam?
Yes
No
Do you give permission for your young person to be involved in media work
and understand that his/her interview and/or image may be broadcast
Yes
and/or printed in the media?
No
BYC will not pass on any details about your young person to any other
organisation or individual. Occasionally however the media need the
contact details of a young person for interview purposes. This number will
only be given out with the young person’s prior consent. Are you happy for
BYC to pass on the contact details only of your young person to the
media?
Yes
No
In line with BYC policy, we also require the young person’s own consent for the use of their own
image, likeness, voice and contact details.
<< This section must be completed by the young person >>
May we use your photograph in BYC programmes and/or other printed
publications that we produce for promotional purposes?
Yes
No
May we use your image on the our web sites and on our official social
media pages
Yes
No
May we record your image on video or web cam?
Yes
No
Do you give your permission to be involved in media work and understand
that your interview and/or your image may be broadcast and/or printed in
the media?
Yes
No
Yes
No
BYC will not pass on any details about you to any other organisation or
individual. Occasionally however the media need the contact details of a
young person for interview purposes. This number will only be given out
with your prior consent. Are you happy for BYC to pass on your contact
details only to the media?
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Emergency contact details
Parent /Guardian Name and relationship to young person:
Home Address:
Home Tel No:
Work Tel No:
Mobile No:
Alternative emergency
contact - name and
telephone no:
Name & Address of Family Doctor: __________________________________________________
______________________________________________________________________________
Doctor’s Tel No: _________________________________________________________________
Parent/guardian declaration
<< This declaration must be completed by the parent/guardian or young person if over 18>>
I consent to the young person named on this form attending BYC events, including British Youth
Council Conventions and other subsequent events, publications and media interviews.
I agree to members of the BYC staff giving my child’s emergency contact details to the emergency
services in order to gain permission for any treatment or medication considered necessary to be
administered. I agree to inform the British Youth Council in the event of any changes relating to
the information on this form during the young person’s time as a youth representative.
I have ensured that the young person named on this form understands, as far as reasonably
possible, that it is important for his/her safety and the safety of the group as a whole that any rules
and instructions given by staff in charge are obeyed.
I understand that while the BYC staff are in charge they will take all reasonable care of the young
people and unless they are negligent they cannot be held responsible for any loss, damage or
injury suffered by any child arising during BYC events.
Parent / Guardian signature:
Date:
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