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YMCA
- About Us
- News
- Careers
What we do
Get Involved
- Events
- Room Sponsor
Reports & Findings
Contact Us

Find a Service

Donate

Home
YMCA
- About Us
- News
- Careers
What we do
Get Involved
- Events
- Room Sponsor
Reports & Findings
Contact Us

Home
YMCA
- About Us
- News
- Careers
What we do
Get Involved
- Events
- Room Sponsor
Reports & Findings
Contact Us

Find a Service

Donate

Birmingham Community Programmes

Something exciting is on the way! We’re launching a brand-new youth offer for young people across Birmingham – a safe, welcoming space to get involved, try new things and have fun.

Delivered from our Erdington site, the programme will be co-produced with young people and shaped around your ideas. Expect a mix of sports, arts and crafts, cooking, music and loads more.

Want to hear more or sign up early? Fill out the registration form below and we’ll be in touch as soon as we’re ready to launch.

Send us a message

Registration Form

Young Person's Details

Your Name(Required)

First Last

D.O.B.(Required)

Day

Month

Year

Your Address

Street Address Address Line 2 City Zip/ Postal Code

Medical Information

Do you consider yourself to have any disabilities? (Please State)

Do you consider yourself to have any allergies? (Please State)

Do you consider yourself to have any Medical Conditions? (Please State)

If your child/young person needs prescribed/un-prescribed medication while in the care of YMCA Black Country Group, please inform the project manager in advance. You will need to fill in a medication consent.

Doctors Information

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Doctor's Phone Number

Doctor's Email

Parent/Guardian Details

Name(Required)

First Last

Preferred Method of Contact(Required)

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Alternative Emergency Contacts

Name

First Last

Relationship to Young Person

Phone

Name

First Last

Relationship to Young Person

Phone

Interests & Support

This field is hidden when viewing the form

Please tick all that apply

Mental Wellbeing Workshops

Physical Activity

Cooking Workshops

Creative Workshops

Pre-employability, learning and skills

Health & Nutrition

Money Management

Counselling

Please tick all that apply

Consent

Activities & Trips

I agree to my child/young person taking part in activities run by YMCA Heart of England, including trips out.

Transportation

I agree to my child/young person being transported in YMCA minibuses, private hire vehicles, coaches or public transport

Your Data

I confirm that I am over the age of 13 and I consent to my personal and special category data being collected and processed by YMCA in order to fulfil their services.

Your Child's Data

I confirm that I am the parent or guardian of this child and I consent to their personal and special category data being collected and processed by YMCA in order to fulfil their services.

Medical Treatment

I consent to my child/young person receiving any emergency medical treatment whilst in the care of YMCA. Including dental, medical or surgical treatment including administration of anaesthetic.

In the event of a medical emergency, every possible effort will be made to contact you or your named emergency contact. We will always follow the advice of the medical practitioner treating the named child/young person.

Print Name

Name

Date Completed

DD slash MM slash YYYY

Creating Positive Outcomes

Nursery

Creating positive outcomes with children and young people in their communities, and support for families with nursery, daycare, holiday and year-round programmes.

Explore Now

Platforming Youth

Youth & Community

Supporting young people and families across Birmingham and Coventry, with a focus on local needs and helping communities belong, contribute and thrive.

Explore Now