Register - Youth 2000 Project

Do you consider yourself to have a disability or medical condition?:

Are you care experienced

Yes No

Do you have caring responsibilities? If yes, please tick all that apply

None Primary carer of a child/children (under 18) Primary carer of disabled child/children Primary carer of disabled adult (18 and over) Primary carer of older person Secondary carer (another person carries out the main caring role) Prefer not to say

Are you currently working with any other agencies? (Social work, family support worker, activity agreement, etc...)

Y2K exists to provide young people a safe space of their own, and as such Y2K seeks to create an environment that is open and non- judgemental for all young people. Any form of bullying behaviour or behaviour such as vandalism will not be tolerated in any form and should evidence of this be presented appropriate action will be taken.

Authorisation for Photography

Y2K occasional produces reports or publicity material about our work; we require the consent of parent/guardian for the use of such photographs. Young people will be full informed of how their picture will be used.

If you are 17 years of age or older, please check the box below to indicate your agreement:

Young Person's Photography Agreement

I grant permission to Y2K to occasionally use photographs of me in reports or publicity material. I understand that Y2K may use my photo without further notification.

If you are under 17 years of age, please have your parent or guardian complete the following section:

Parent/Guardian Photography Agreement

I, parent or guardian, hereby grant permission to Y2K to occasionally use photographs of [Participant Name] in reports or publicity material.

Insurance Information

Y2K’s Liability Insurance will meet claims resulting from accidental injury or damage to property if it is proved it was caused by negligence of Y2K or a Y2K employee. Y2K insurance will not cover loss or damage to personal property. Much of the statistical information required for funding applications is within this membership form and may be used for this purpose. This information may also be shared with other professionals and organisations. Please indicate if you do NOT wish to grant permission for this by speaking to any member of staff.

Parent/Guardian Agrees

Relationship to you:

If you (parent/guardian) wish to opt-out of information sharing, please inform a staff member.

For participants aged 13 and over: Your signature below signifies your agreement to the terms and conditions. No parent or guardian signature is required

For participants under 13: To participate, please sign below and have your parent or guardian sign in the designated space.

Unlock Your Potential! Register Today and Start Your Journey

Unlock Your Potential!

Register Today and Start Your Journey

Your Details

Emergency Contacts

Just a little bit more information about you

Authorisation for Photography

Insurance Information

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