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This membership form must be completed by an 18+ year old parent/guardian of the child being registered.

Since 1971, Hayes Town Chapel Youth Club has been well attended and enjoyed by many local children. We believe that the following form is necessary for the Youth Club to remain successful and enjoyable for all. Fields marked in bold are required. We thank you for your co-operation.

Data protection: Your information will be used only by Hayes Town Chapel for contacting the Parent/Guardian of the child in case of an emergency, and as a point of contact for general notices.

Your Child’s Information:

(Your child must be aged 11-16)

First Name:

Last Name:

Date of Birth:

Home Telephone/Mobile No.:

Address (line 1):

Address (line 2):




Does your child have any special dietary requirements:

Please make us aware of any allergies your child suffers from:

Does your child have any medical conditions that you would like us to know about:

Is there anything else you’d like us to know that would help us to care for your child:

Parent/Guardian’s information:

(These contact details will be used in the case of an emergency)

First Name:

Last Name:

Relationship to Child:

Telephone No.:

Mobile No.:


Please read the following rules and conditions of Hayes Town Chapel’s Youth Club. To maintain a friendly environment for games, activities and to provide an opportunity for children to learn about the Christian faith, these are the rules which all the children are expected to adhere to at all times whilst attending the Youth Club.

  1. Children are registered and subs collected on arrival after 7:30pm. Any child deliberately arriving late, thereby missing the Bible study (at 7:40pm), 2 weeks in a row, will face a 1 week exclusion from the Youth Club.
  2. If a child is disruptive during the Bible study or movie quiz/discussion times, they will be warned once. If a child is repetitively disruptive they will be asked to leave the Youth Club immediately for that particular evening. They are welcome to return following week.
  3. Foul language and inappropriate conversation will not be tolerated. ie: The misuse of God’s name and the name of our Lord Jesus Christ, swearing and language that is not acceptable.
  4. We will allow no physical or verbal harassment of any nature at any time. This includes inappropriate or hurtful social media messages, sent between Members, that might be brought to the attention of the Youth Club Leadership Team. If your child should be the victim of this type of behaviour, via another Youth Club Member, the incident needs to be reported to the Youth Club Leadership Team immediately.
  5. All leaders/helpers are to be respected and obeyed at all times.
  6. The equipment and property of the Youth Club is to be respected. Compensation may be required in regards to any costs incurred due to misuse and damage.
  7. No drugs, alcohol, cigarettes, fireworks or weapons are to be brought onto the church premises.

Terms & Conditions:

  1. Failing to comply with the above rules will result in the child being warned once only. If repeated, the child will be sent home or suspended, depending on the severity of the incident.
  2. Sometimes children decide to leave before the end of the evening. If your child wishes to leave at any point before closing time at 10:00pm, one of the Leadership Team must be notified.
  3. The Youth Club is not responsible for your child before they arrive or after they have left the church premises. This also applies when the Youth Club closes at 10:00pm.
  4. Photographs may be taken of the children and activities of the Youth Club for newsletters, publicity or year-book type applications. If you do not wish your child to be photographed, please make this clear to one of the leadership team.
  5. As part of our weekly activities, we watch a section of a movie that will be completed over a number of weeks. These movies are carefully chosen by the leadership team for their potential to inspire the children and provoke thought and discussion. The highest age rating of the movies we choose is 12. If you would like to know the movie we are showing at any time, or would prefer that your child not to see a movie rated 12, please make this known to one of the leadership team.


By entering your name below, you are confirming you have read and are in total agreement with the above rules, terms and conditions. Your name will be accepted as your personal signature.

Your full name:

Please check this box to confirm you are over 18 years of age, and have read and understood the above terms and conditions: