Forename(s): - County Durham Sport



Please return your completed forms to: County Durham Young Volunteer Programme,

County Durham Sport, The Sjovoll Centre, Front Street, Pity Me, Durham, DH15BZ

|Forename(s): |

|Surname: |

|Date of Birth: |Gender: Female/Male/Other/Prefer not to say |

|Mobile telephone: |

|E-mail address: |

|PLEASE INCLUDE A VALID EMAIL ADRESS THAT YOU REGULARLY CHECK AS THIS WILL BE THE MAIN METHOD USED TO CONTACT YOU |

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|Address: |

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|Post code: |

|Emergency Contact Name: |

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|Telephone No: |

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|Relationship to applicant: |

|School / College attending (if applicable): |

|Do you currently volunteer at a club? Yes/No |

|If you volunteer, please state the club you volunteer at: |

|What areas would you like to volunteer in? |

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|Do you consider yourself to have a limiting illness? Yes/No |

|If Yes, what is the nature of the illness? |

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|Agreement |

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|County Durham Sport & Partners; |

|Will work closely together to ensure the success of the Scheme |

|Will promote volunteering opportunities to the young leaders and volunteers, and offer support and training where appropriate |

|Will communicate with all successful applicants on a regular basis |

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|Applicant; |

|I will attend all events and workshops at the required time and if unable to attend will give appropriate notice to the event/workshop organiser or the applicant |

|will incur the FULL COST of the course fee (£25 - £100 dependent upon course registered) |

|I will ensure I make my own transport arrangements where required to attend workshops/events |

|I will wear appropriate clothing when attending any events/workshops |

|I will always be polite and well mannered when representing the Leadership Academy at any event/workshop |

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|Signature …………………………………………………… |

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|Print Name ………………………………………………….. |

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|Date …………………….. |

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Parental / Guardian Consent Form (For under 16s Only)

Confidentiality: Details on this form will be held securely and will only be shared with coaches or others who need this information in order to meet the specific needs of your child.

|Name of child/young person: | |

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|Address: | |

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|Date of Birth: | |

|Name of parent / carer: | |

|Day time Tel No | |Mobile Tel No parent/carer: | |

|parent/carer: | | | |

|Email address parent/carer: | |

|Emergency contact information: |

|Name of alternative adult who can be | |Relationship to young | |

|contacted in an emergency: | |volunteer: | |

|Day time Tel No alternative adult: | |Mobile Tel No alternative | |

| | |adult: | |

|Please confirm if there any activities |Please give details: |

|that you can / young person cannot | |

|participate in? | |

|Medical information: |

|Any specific medical conditions |Yes (please give details): |No: |

|requiring medical treatment? | | |

|Details of medication | |

|required(pain/flu/inhaler): | |

|Any specific limiting medical condition|Yes (please give details): |No: |

|or disability? | | |

|Any allergies? |Yes (please give details): |No: |

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|Consent information: |

|For this consent the organisation refers to County Durham Sport and its partner SGO areas (Durham & CLS, Derwentside, Easington, Wear Valley & Teesdale, |

|Sedgefield). Completed by a parent or guardian if under 16 years of age. |

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|Please tick the boxes below |

|I give my consent that if an emergency medical situation arises, the organisation may act as loco parentis. If the need arises for administration of first aid |

|and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances that all |

|reasonable steps are made. |

|I confirm that I have read, or been made aware of, the organisation’s policies concerning: |

|Codes for conduct for parents, coaches, children & young people |

|Transport policy |

|Changing room policy |

|Photography, videoing, texting and use of social media policies |

|I can confirm that the young volunteer is aware of the organisation’s code of conduct for children and anti-bullying policy. |

|Photography and Filming Consent information: |

|In accordance with our child protection policy we will not permit photographs, video or other images of young people to be taken without the consent of the |

|parents (or carers) and the child. |

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|We will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used |

|inappropriately you should inform County Durham Sport immediately. |

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|please tick the boxes below |

|To be completed by parent (or carer) (under 16s Only) |

|I give permission for my child’s photograph to be used for display purposes |

|I give permission for my child’s photograph to be used within other printed publications |

|I give permission for my child’s photograph to be used on the organisation’s websites |

|I give permission for my child to be videoed for use on the organisation’s websites |

|I give permission for my child’s photograph to be used on the social media pages |

|I give permission for my child to be videoed for use on the social media pages |

|I can confirm that I have read, or been made aware of how these images or videos will be stored within the organisation. |

|To be completed by the Young Volunteer: |

|I give permission for my photograph to be used for display purposes |

|I give permission for my photograph to be used within other printed publications |

|I give permission for my photograph to be used on the organisation’s websites |

|I give permission to be videoed for use on the organisation’s websites |

|I give permission for my photograph to be used on the social media pages |

|I give permission to be videoed for use on the social media pages |

|We may wish to use occasional text reminders to young volunteers up and coming events or key information regarding the programme, along with emails. |

|If you agree to the young volunteer (or yourself) receiving text reminders please supply an appropriate contact number below. |

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|Contact number for text reminders______________________________________ |

|Signature of parent (or carer) (Under 16): |Print name of parent (or carer) (Under 16): |

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|Date: |

|Signature of young volunteer: |Print name of young volunteer: |

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|Date: |

In order to fulfil the funding requirements for this programme, County Durham Sport is required to collect the following information. This data will only be used to report on the number of participants on the programme, and will not be linked to any personal information.

|What is your child’s ethnic group? |

|A White | |B Mixed | |C Asian or Asian British | |

|English |( |White & Black Caribbean |( |Bangladeshi | |

|Irish |( |White & Black African |( |Indian |( |

|Scottish |( |White & Asian |( |Pakistani |( |

|Welsh |( |Other Mixed |( |Other Asian |( |

|Other White |( | | | |( |

|D Black or Black British | |E Chinese or Other Ethnic Group | |

|Caribbean |( |Chinese |( |

|African |( |Other Ethnic Group |( |

|Other Black |( | | |

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|Prefer not to say ( | | | |

Privacy Statement

County Durham Sport (CDS) is a ‘Data Controller’ as defined by the Data Protection Act (2018). This means that CDS has a duty of care towards the personal data that it collects and uses.

We are committed to ensuring the responsible collection and use of personal data in the course of its business. We will ensure that personal data is processed fairly and lawfully, and that the rights of data subjects are properly respected.

By submitting this form, the applicant and their parents/guardians are consenting for the personal data provided to be used for the purpose of administering the Leadership Academy programme, including communication regarding acceptance onto the programme and the co-ordination of the programme once selected. Personal information gathered will only be accessible to and viewed by appropriate members of County Durham Sport and the relevant School Sports Partnership, to ensure that the programme is effectively delivered. Information will be kept for a period no greater than 12 months following the completion of the programme, to support monitoring and evaluation and to promote the Leadership and Volunteering event in 2019. 

Applicants or their parents/guardians may at any time withdraw their consent for CDS to continue to hold the personal data provided on this form. To withdraw consent, please email CDS at cdsport@ to inform us. However, please note that withdrawing consent will mean that CDS will be unable to process this application, making it unlikely that the applicant will be able to participate on the scheme.

Our full Privacy Statement can be found at .

If you would like to read the County Durham Sport Child Protection Policy, including guidance on the use of photography, then please visit or contact County Durham Sport on 0191 3077117 to request a copy.

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County Durham Young Volunteer Programme

Application Form 2019-20

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