Bedford Radios Youth Radio Project

Young Persons full name

Young Person known as name (if different)

Date of birth

Parent or Guardian name (who is completing this form)

Email or you (Parent or Guardian completing this form)

Emergency Contact Name

Emergency Contact Relation with Young Person

Emergency Contact Phone Number

Any access needs, disability requirements or anything we need to be aware of (or put NA/NONE)

Confirm that the young person attend ALL dates (type CONFIRM)

Confirm that you give consent for the young person to take part (type CONFIRM)

Photography, video and audio will be taken to promote the project and share with partners type CONFIRM to show you've read this

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