Become a Member

Young Person Details
Ethnic Background
Medical Information
Please provide us with as much information as possible regarding the member's health. Please note a member of staff will contact you if they feel further information is required.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Parent Consent Form for the use of the Gym

The purpose of the gym is to provide safe and individualised exercise to improve health and fitness. Exercise may include cardiovascular and aerobic activities, but the resistance exercises are only for young people aged 16+.

Member's Emergency Contact
First Emergency Contact
Second Emergency Contact
Gift Aid

Help us turn your £5 membership into £6.25 by just ticking the box below which shows you have paid your membership and agree to the statement below.

I enclosed a minimum donation of £5 for the annual membership of Carlisle Youth Zone.

I am a UK tax payer and would like Carlisle Youth Zone to treat all donations I make or have made in the last four years as Gift Aid donations until further notice. I confirm I have or will pay an amount of Income tax year (6 April to 5 April) and/or Capital Gains tax for each year that is at least equal to or higher than the tax claimed by all Charities and CASCs from HM Revenue and Customs on my donation(s). I also understand that Council tax and VAT do not qualify. I understand that the charity will reclaim 25p of tax on every £1 that I have given.

 
Member's Agreement

• I have read, understood and completed this application form to the best of my ability and any questions I had have been answered to my full satisfaction. 

• I agree to inform Carlisle Youth Zone if my details or health change.

• I agree to take full responsibility for my health and safety when participating in physical activities and sports provided by Carlisle Youth Zone. I understand that I participate in physical activity at my own risk. Carlisle Youth Zone will not be held liable for any bodily injury caused to individuals participating in physical activity. 

• I agree to respect and follow Carlisle Youth Zone’s Behaviour Policy. 

• You may be photographed or filmed while taking part in activities at or away from Carlisle Youth Zone.
These images may be used for promotional/reporting purposes to show others what we do.
Please tick this box if you do not want your image to be used in this way. 

 
Parent /Guardian Agreement (if the member is under 16)

• I agree to the above and that the named young person can be a member of Carlisle Youth Zone and take part in all activities at or away from the building. 

• Please provide your email address if you would like to be kept up-to-date with information about timetables, holiday clubs, special offers and new activities. 

Data Protection Act 1988. The information provided in this form is confidential and Carlisle Youth Zone will use it only to faciliate the scheme(s) on which you are registered.