Register Your Club


 
Name of Youth Club/Group
 
Email
 
Venue Name
 
Venue address
 
Town
 
County
 
Postal code
 
Telephone
 
Disabled Access
Yes No
 

Name for all correspondence
 
Full address
 
Town
 
County
 
Postal code
 
Telephone number (work)
 
Telephone number (evening)
 
Mobile
 
Email address
 

Name of leader if different from above
 
Telephone number
 
Email address
 

Name of Chairperson/Secretary if diffrent from above
 
Telephone number
 
Email address
 

PROFILE OF MEMBERS for statistical purposes we need overall numbers not averages

 
5-7
 
8-10
 
11-13
 
14-16
 
17-19
 
20-25
MALE
 
 
 
 
 
 
FEMALE
 
 
 
 
 
 
Members with Special Needs
 
Physical
Learning
Others
 
 
 
Ethnicity profile of members
 
Black
Asian
White
Others
 
 
PROFILE OF WORKERS
 
Voluntary Part time Age 18+
 
Voluntary Full time Age 18+
 
Paid Part time Age 18+
 
Paid Full time Age 18+
 
Young Leader Age 13 - 17
 
 
 
MALE
 
 
 
 
 
 
 
FEMALE
 
 
 
 
 
 
 
Worker with Special Needs
 
Physical
Learning
Others
 
 
 
Ethnicity profile of workers
 
Black
Asian
White
Others
 
 
 
Personnel
Name
Email Address
Telephone
 
Safeguarding Contact
 
DBS ID Checker
 
First Aider
 
PROFILE OF CLUB/GROUP
 
Days and Times of Opening
Please state times of sessions
Mon
Tue
Wed
Thu
Fri
Sat
Sun
 
PLEASE STATE DAYS AND TIMES YOUR CLUB/GROUP IS CLOSED FOR HOLIDAYS
 
Please Indicate if you would like support with holiday activities including any details you may have
 
What is your district council area:
Corby BC
Daventry District Council
East Northants District Council
Kettering BC
Northampton BC
Wellingborough BC
South Northants District Council
 
Does your club have the following:
Management committee
Yes
No
Child protection policy
Yes
No
Equal opportunities policy
Yes
No
Health and safety policy
Yes
No
DBS Check
Yes
No
Number of DBS Registered
 
What is your group's focus
Faith Based
Special Needs
Sports
Music / Drama   Others Specify  
Are you a faith group
Yes No
 
Insurance Declaration
 
Name of the Insurer
Name of the Insurance Broker
Policy Number
Renewal Date
Employers Liability limit of Idemnity
Public Liability of Idemnity
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APPS

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          Business

Contact Us

Tel: 01604 499699
Fax: 01604 797901
Email: yd@nayc.org
Address:
King's Park Headquarters
King's Park Road
Moulton Park
Northampton
NN3 6LL