Child/Young Person Application Step 1 of 4 25% Please read our FAQ and the information below before submitting your form: – The child requesting support must be 5+ and live or attend school in the Wokingham or Reading boroughs – Me2 Club volunteers and staff cannot provide transport – We are only able to provide one volunteer for one weekly activity per child – We cannot support at SEN clubs, holiday/one-off activities, weekend activities, or activities starting before 4pm – Me2 Club do not run our own weekly activities, parents/carers are responsible for arranging and funding the activity – You must already have a place booked at the activity (or be on a waiting list for a place) – If you are looking to receive a volunteer for more than one child, please complete the form separately for each child It can take up to a week before you receive a confirmation email regarding your application. Please check your spam folder and if you haven’t heard back after a week you can contact us at info@me2club.org.ukYou will need to have a place booked at the activity you would like Me2 Club to support at before you can apply(Required)You will need to provide the time and day of the activity on the next page. Your application will be turned down if you do not have a place at an activity or are not on the waiting list for an activity. I have read the information above and my child currently has a place booked/is on the waiting list for an activity ActivityDay(Required) Mon Tue Wed Thur Fri Activity Start Time(Required)Activity start time must be no earlier than 4pm Activity Type/Organisation(Required) Activity Location(Required) Child/Young Persons Details First Name(Required) Surname(Required) Address(Required) Street Address Address Line 2 City County Postcode Date of Birth(Required) DD slash MM slash YYYY Education(Required) Gender(Required)FemaleMalePrefer to self describeDo not wish to discloseEthnic Origin(Required)White – English/Scottish/Welsh/Northern Irish/UKWhite – IrishWhite – Gypsy or Irish TravellerWhite – Other White BackgroundMixed Ethnic BackgroundAsian/ Asian UK – IndianAsian/ Asian UK – PakistaniAsian/ Asian UK – BangladeshiAsian/ Asian UK – ChineseAsian/ Asian UK – Any other Asian BackgroundBlack/ African/ Caribbean/ Black UK- AfricanBlack/ African/ Caribbean/ Black UK- CaribbeanBlack/ African/ Caribbean/ Black UK- Any other Black/ African / Caribbean BackgroundOther Ethnic Group – ArabOther Ethnic Group – Any other ethic groupDo not wish to discolse ethnic group Parent/Carer Details Parent/Carer Name(Required) First Last Relationship to child(Required) Parent/Carer Address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Parent/Carer Home Phone(Required)Parent/Carer Mobile Phone(Required)Parent/Carer Email(Required) Support InformationPlease give brief details of your child’s additional needs and how it affects them and their behaviour. During the home visit we will endeavour to collect specific and detailed information.(Required)Does you child have any specific support needs we should know about?(Required) Yes No Please provide details of specific support needs.How did you hear about the Me2 Club?(Required)Social WorkerLeafletWord of MouthOther CharityActivity LeaderPrivacy Policy(Required)I have read and understood the Privacy Policy regarding the personal data contained in this referral. I consent to my personal data and the personal data of my child to be processed by Me2 Club for purposes of volunteering and supporting the work of Me2 Club *required I consent Me2Club Work(Required)I would like to be kept up to date about the work of Me2 Club and other opportunities to support the charity Keep me informed Don’t keep me informed Newsletter(Required) Send me the newsletter Don’t send me the newsletter I would like to receive the Me2 Club Newsletter via email.I agree to photographs/media recordings of my child during the activity, with the possibility that their image may be used for publications, social media and/or marketing publicity. Note: if consent is not given, Me2 Club will not use any images taken during the activity that contain the child/young person(Required) I consent I do not consent Δ