Aim Higher Membership Form
Sign up to get access to all our information & events.
Young Persons Name
Young persons difficulties
Young Persons Address
Street Address Line 2
Your Contact Email
Your Contact Phone Number
Does the young person have an Education, Health & Care plan?
Are there any particular barriers you are facing or worried about?
What support/activities would you like offered to parents/carers?
What support activities would you like to see offered for your young person?
If "Yes", What age please?
Do we have your permission under GDPR to keep your information?
Are there any medical conditions (ie. allergies, epilepsy, asthma, diabetes) which we should be aware of?
If yes please detail below
Child Photo/Video consent
We would be grateful if you would fill in this part of the form to give us permission to take photos of your child and use these on our printed and online publicity.
I give Aim Higher permission to take photographs and/or video of my child. (Parent/Carers Name)
I grant Aim Higher full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fund raising, publicity or other purposes to help achieve the groups aims. This might include (but is not limited to), the right to use them in their printed and online publicity, social media, press releases, and fund raising applications. (Parent/Carers Name)
Name Of Child
Name Of Parent/Guardian
We will hold your details as long as is necessary so as to be able to deliver our services, and continue your membership. By clicking this box I hereby give my permission to the above terms and conditions
I Agree to the above terms and conditions
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