Street Champions registration form

Thank you for volunteering to work with the Council. If you are under 16, please ask your parent or guardian to complete this form on your behalf.

Your details

Do you...



For example: 11/06/1975
Preferred method of contact:


Photos and videos

Photographs/videos are taken of participants during activities. Do you give your consent to be photographed/videoed and for these images to be used for publicity?

Equipment

Please tick the boxes you’re interested in so we can supply you with the right equipment:

Child/young person/vulnerable adult

If you are filling this on behalf of your child/young person/vulnerable adult, please complete this section. If not, please proceed to the end of this form and click submit. The information is confidential and will be only used for the safety of your child/young person/vulnerable adult. 
Illness or allergies









Emergency contacts

Contact one

Contact two

Contact three

Doctor's details

Important: If a child/young person/vulnerable adult suffers illness/injury and the parent/guardian of him/her cannot be contacted immediately by telephone or otherwise, the staff will make speedy arrangements for their appropriate care.

Photos/videos

Photographs/videos are sometimes taken of participants during activities. Do you give your consent for your child/young person/vulnerable adult to be photographed/videoed and for these images to be used for publicity?

Parent/guardian details

Consent