YES Registration and Monitoring Form

YES Registration and Monitoring Form

Please fill in this form so that you can take part in YES Activities. You don't have to fill in the whole form, but if you can, it will help us to provide more activities for you!
Which activity are you attending? *

Resource Productions Into Film Club Resource Productions Script Saturday Aik Saath Volunteering Aik Saath Slough Young Carers Aik Saath Juice with Jemma (Girls Only) Empoword Poetry Fitness with Team GB Athlete Mahama Cho Gaming night BFI Film Academy
Full Name *

First Name Last Name
Date of Birth *

Day Month Year
Date
Address *

Door/Flat No

Street

Post Code
Home Phone Number
Mobile Number
Email *
example@example.com
Gender *

Male Female Prefer not to say
Ethnicity

Bangladeshi Indian Pakistani Other Asian Background Black/British African Black/British Caribbean Other Black Background White and Asian White and Black African White and Black Caribbean Other Mixed Background White British White Irish Other White Background Chinese Other Ethnic Group Prefer not to say
Do you consider yourself to have a disability? *

Yes No Prefer not to say
If Yes, please tell us the type of disability you have:
Employment Status- Please tick one from the list below

School/ Sixth Form University/ College Part-Time Education Other Education Apprenticeship Full-Time Employment Part-Time Employment Volunteering Looking for work Other (Not in Education, Employment or Training)
What School do you attend (if applicable)?
YES Target Group

Involved with YOT Anti-Social Behaviour Child Protection Register Substance Misuse Non/Poor Attender Asylum Seeker/Refugee Young Carer Looked After/In Care Care Leaver Parent Negative Peer Group Learning Difficulties/SEN
Religion / Faith / Belief

Buddhism Christianity Hinduism Islam Judaism Sikhism No Religion Atheism Prefer not to say
Sexual Orientation

Bisexual Heterosexual/Straight Gay Woman/Lesbian Gay Man Prefer not to say
Activity Levels: On average how many times a week do you participate in sport for at least 30 minutes? Please tick below:

0 1 2 3 4 5+
Health and Well being: Apart from not getting ill, what is your top health priority?

Looking and feeling young, confident and healthy Having a more active social life Having an active and healthy mind Avoiding aches and pains
How information about you will be used: We may share your information with Slough Borough Council and other youth and community organisations so that we can find activities and support that suits you. We would like to send you information about other activities and offers, by post, telephone, email, and SMS. If you agree to be contacted in this way, please tick the relevant boxes.

Post Email Phone SMS
Photography and Filming: During YES activities e or our partners may take photographs or video. These may be used to promote future YES activities online and in print. Please confirm whether you are happy for us to photograph/film you.

Yes No
Emergency Contact's Full Name *
Emergency Contact's Number *
How are they related to you? *

Parent Guardian Carer
Do you have any disabilities, allergies, illnesses, or access needs?
Please list any medication you are taking
If you're happy for YES to follow you on Social Media, please leave your handles below.
Twitter
Instagram
Facebook
Under the Data Protection Act 2018, we are required to gain your permission to keep personal details for you.

YES and its agents may share this information with government and local authority departments and other authorised organisations for administrative, statistical and research purposes. For further information please visit: https://yesslough.org.uk/about-us/privacy-policy-2018/

Completing this form and signing it gives us your informed consent. If you are unable to access the provided links or wish to submit a query in relation to fair processing, please contact the data protection officer at dom@resource-productions.co.uk
Please sign here *

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Today's Date
Follow us on Twitter @yesslough for regular updates.

YES Consortium led by Aik Saath, SWIPE and Resource Productions

www.yesslough.org.uk
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