Teen+ & Ten+ sign up and pay form

Registration Agreement　

By enrolling at mASCot Teen+ Club at Brighton Youth Centre, the member understands that:

he/she attending the session, using Brighton Youth Centre and the facilities does so at his/her own risk.　　
mASCot, shall not be liable for any damage whatsoever arising from any personal injury or property sustained by young person or his/her family on the premises. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs on the premises.　　
Teen+ Club is not a drop off session. They will accompany and be responsible for their young person throughout, or, arrange for another attending adult to hold responsibility for their young person in their absence.　
We would like your consent for videos and photos, which include your young person to be used by mASCot for documentation and website purposes.
We also need your consent for data to be shared with Brighton Youth Centre (Young person name and DOB for BYC funding purposes only)

Registration to join Teen+ or Ten+ Clubs

Name of child*

Parent/Carers Name*

Address*

Email Address*

Message*

Date of Birth*

Phone Number*

Secondary Contact Number*

Does your child have a diagnosis of ASC and/or any other condition, if so please give details*

Does your child have any allergies or other medical conditions, if so please give details*

Any dietary requirements, if so please give details*

Anything that would be helpful for us to know e.g.: young persons triggers/sensitivies, if so please give details*

Any special interests, if so please give details*

Ticking the boxes below shows you have read and agreed our mASCot agreement *

I accept the terms of the registration agreementI give consent for use of videos and photosI give consent for data to be shared with BYC

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Here's how you pay

You can pay:

with Debit/Credit card.

£15.00 half a term

£30.00 whole term

Bank transfer details

pay mASCot

Co-Op

Account Number 65499546

Sort Code 08-92-99

Once we have received you form and payment we will send you an email of confirmation

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