juniorteam

Junior Team (Age 12-15) Registration Form

* Indicates required field

Name *

First

Last

Date of Birth *

Telephone *

Email *

Medical/allergy/disability/additional needs information *

Confidential Declaration for Children's Club Workers

Guidelines from the Home Office following the Children Act 1989 advise that all voluntary organisations, including churches, take steps to safeguard children who are entrusted to their care. You are therefore asked to make the following declarations:-

Do you have any current or spent criminal convictions, cautions, bindovers or cases pending? *

Yes No

Has your conduct ever caused, or been likely to cause, harm to a child or put a child at risk, or, to your knowledge, has it ever been alleged that your conduct has resulted in any of these things? *

Yes No

Any additional comments *

Because of the nature of the work for which you are applying, this post is exempt from the provision of Section 4(I) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act 1974 (Exemptions( Order 1975, and you are therefore not entitled to withhold information about convictions which, for other purposes, are 'spent' under the provisions of the Act. Failure to disclose such convictions could result in the withdrawal of approval to work with children at the holiday club.

Parent / Guardian Name *

First

Last

Parent / Guardian Phone Number *

Name of Responsible Adult onsite *

First

Last

Reference Request

Name of Referee 1 (e.g. Church Leader/Youth Leader if appropriate) *

First

Last

Contact Number *

Email *

Name of Referee 2 *

First

Last

Contact Number *

Email *

Thank you in advance for your help, we will contact you after the end of June deadline with further information and confirm where you will be helping.

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