Member Details

Name:
Address:
Post Code:
Date of Birth:
Age:
Telephone number:
Email Address:
Ethnicity:

Emergency Contact Details

Name:
Address:
Telephone Number:
Relationship:

Medical Details

Doctor’s Name:
Address:
Telephone Number:

Does your child/young person have any medical conditions including disability?

Yes No

If Yes, please give details about the condition and any medication they require:

How did you hear about the project? Please select Through a friend Through your school or professional worker Online Other

Parental Consent Nb. If you are under the age of 18 your parent/guardian must complete on your behalf. The Archway Project is a motorcycle training youth centre by ticking the box below you are consenting to the above named member being able to take part in activities arranged within the Archway Project Centre. All members will be expected to adhere to club rules any members absent from two consecutive weeks without contacting the club may forfeit there membership. Consent Agreed

Parent/Guardian name: Relationship