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» Youth Group Enrolment
Youth Group Enrolment
Service Referral
Thank you ! Your message has been sent. We will contact you within the next 7 days.
Youth Group you are applying for.
Angus
Dundee
Parent/Name
Address
Telephone Number
Email Address
Relationship to Child
Second Emergency Contact Name
Address (if different from above)
Emergency Contact Telephone Number
Childs Name.
Address (if different from above)
Post Code
Date of Birth.
Gender.
Male
Female
Prefer Not Say
Other
If Other Please State.
Alongside ADHD what other conditions, if any, does your child/young person have?
Please provide us with a copy of your young person’s formal diagnosis letter from CAMHS, if you have not already done so
Allergies/any other relevant information
If there are any other agencies involved with you and your child/children, please give us their contact details below
I agree for my child to be photographed/recorded by video for funding and marketing purposes
I agree for the group to use my child’s photograph while participating in activities for use on social media
I agree for my child to take part in pre-arranged outings
Declaration; I agree to pay the group fee of £10.00 per week except for 2 weeks granted holidays within the year. I agree to pay the annual administration fee of £25.00
Signature of Parent/Carer
Date signed
How did you find out about Dundee and Angus ADHD Support Group
We need parents’ volunteers to help us fundraise throughout the year. Without your support we miss vital funding for the youth group and parent support groups. Can you give us 5-10 hours per year to support us?
Yes
No
If yes, please state your availability below
Does anyone in your household have a hidden talent that you could share with the youth groups? Let us know below
UK GDPR – now replaces previous GDPR polices post Brexit and come into force on 1st January 2021 and is tailored by the Data Protection Act 2018. We need to prove that we have your consent to keep a hard copy of your personal details (e.g. Name, Address, Phone Number). We also need to prove that you have given explicit consent to receive any information from us. If you have any questions about this, please contact louise@adhddasupport.org In order to continue receiving information from us please complete the information below. Dundee and Angus ADHD Support Group needs to hold a copy of your personal data so we can contact you about our youth groups, parent support groups, fundraising activities, holiday clubs, newsletters and external events that we may receive information about. Your personal data will be held in our database until you no longer wish to receive any information from us, and you ask us to remove your details. You can withdraw consent at any time, and you can do this by contacting us.
How do you prefer to be contacted?
Email
Letter
Phone
Signature
Post Code
Post Code
Telephone Number
Finish
If you are happy with your details above please tick the box and click the send button
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