First name *

Please enter the first name of the young person wishing to take part in the group.

Surname *

Please enter the surname of the young person wishing to take part in the group

Date of birth *

Please enter the date of birth of the young person wishing to take part using the format DD/MM/YYYY

Which school year will the young writer be in from September 2019? *

Please select the relevant school year the young person will be in from September 2019.

Which group would you like a place in? *

Please select the group you are interested in. If the group has SOLD OUT in the title, please do not make payment and we will be in touch to discuss options. If there are other groups or explanations, there will be a space for messages later in the form.

Please enter in any information you would like to share about the groups and your choices

School attended *

Please let us know which school the young writer will attend from September 2018. We need this for safeguarding reasons. Please enter "home educated" here if this is the case.

Please indicate any allergies, medical conditions or other needs

Tell us of any needs relating to allergies, medication, conditions or additional needs our writers may need to be aware of.

Parent / Guardian first name *

Please enter the first name of the person we should contact regarding the young writer's place in the group now and in the future

Parent / Guardian surname

Please enter the surname of the person we should contact regarding the young writer's place in the group now and in the future

Parent / guardian email address *

Please enter the best contact email address. We will send email reminders to this address as well as other information. We will not pass it on to third parties.

Parent / guardian mobile phone number *

Please enter the best contact mobile phone number. We will use this in case of emergencies during a session, but will also send text reminders the day before the group meets.

Home postcode *

Please give us the young writer's usual postcode. We use this when reporting to our funders.

Home address line 1

First line of the young writer's usual home address

Home address line 2

Second line of the young writer's usual home address

Home address line 3

Third line of the young writer's usual home address, if applicable

Home address line 4

Fourth line of the young writer's usual home address, if applicable. We already have the postcode listed above, thank you.

Is your young writer in receipt of the government's "pupil premium"?

Yes
No
Prefer not to say

We are asked to provide this information by our funders. We will need to know the answer if you ask us for a bursary place.

Accompanied or unaccompanied attendance - please choose carefully *

My young writer is in Yr 6 or below and I give consent for them to leave unaccompanied
My young writer is in Yr 6 or below and I or a nominated individual will collect them
My young writer is in Yr 7 or above and I give consent for them to leave unaccompanied
My young writer is in Yr 7 or above and I or a nominated individual will collect them

If your child is in Yr 3-6, we expect a parent or guardian to drop them off and collect them at each session. However, if you are happy for your child to attend unaccompanied please indicate above. If your child is in Yr 7-11 we are happy for them to attend unaccompanied. However, if you would like to drop off and collect your child please indicate above.

Nominated individuals with permission to collect your young writer

Please list here anyone who may collect your young writer from their group. These names will be passed to the lead writer to safeguard your child. Additional names can also be given to the lead writer when dropping off at the session.

Are you happy for your child to take part in visits i.e. to a local gallery or library? *

Yes
No

These visits will always be supervised by the Lead and Assistant Writer and a risk assessment will be carried out in advance of the visit. You will also be informed in advance of the visit which will take place during one of the sessions themselves.

May we use your child’s image in promoted publications that we produce for promotional purposes or on display boards/banners? *

Yes
No

We will not use the personal details or full names (which means first name and surname) of any child in a photo image, on video, on our website, or in any of our printed publications. We will only use images of young people who are suitably dressed, to reduce any risk of such images being used inappropriately.

May we use your child’s image on our website and Facebook? *

Yes
No

Photos and short video clips are a very effective way of communicating and promoting the value of the work we do. They are also a great way for group members to see themselves enjoying being part of a group and learning from or remembering a particular activity or event. Occasionally, we may take photographs or videos of the children/young people who belong to our groups. We may use these images on our website/Facebook/other social media pages.

May we record your child’s image on video or voice on an audio recording? *

Yes
No

We may make a video or slideshow of our groups in action for educational purposes, including remembering a fun activity or event.

Are you happy for your child to appear in the media? *

Yes
No

Very occasionally our group may be visited by the media who will take photographs or film footage of a visiting dignitary or other high profile event. Group members may appear in these images, which may appear in newspapers, or even on TV news programmes. Please note that the press are exempt from the Data Protection Act and may want to include the names and personal details of children in the media. Also, if your child submits writing to be included in Spark Magazine (our online magazine featuring writing by children and young people living in the West Midlands), we will use both the young person’s first and last name unless otherwise agreed.

Payment Method - please indicate how you hope to pay. You can change your mind at the point of payment, but it will help us to know what to expect.

By paying for all the sessions either in one payment or in termly instalments, you are helping to safeguard the future of the groups - thank you.

We expect everyone associated with our activities to behave responsibly. We will alert you if we have any cause for concern and we reserve the right to temporarily or permanently exclude anyone whose behaviour is unacceptable. We do not tolerate any form of offensive behaviour. *

I understand my responsibilities

You can find the child protection policy and code of conduct that the writers have signed here: https://www.writingwestmidlands.org/writing-west-midlands-child-protection-policy/

Worcester Young Writers’ Groups