Insurance Form

What is the name of your club name?

What is your address

What Local Youth Service are you making this application through?

What is your email address

What is the name of your Club Secretary?

What year was the club formed?

How many club members do you have?

What are the age and gender profiles of your Youth Club members

How often does your club meet? (e.g. once a week 6pm-9pm fri evenings)

Please list the activities your club organises:

Please indicate whether your club:
 Owns its own premises Rents its own premises Has the use of premises free of charge

What was the expenditure of your club last year?

Please detail how many of your leaders undertook Child protection training in the last 12 months:
 Male Female Accredited

Please detail how many of your leaders undertook Induction training in the last 12 months:
 Male Female

Please detail any other training undertaken by your leaders in the last 12 months - detail the training type, leader numbers, and gender profile of the leaders

Please state your name and your position in the Youth Club?

captcha