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© 2024 Harrow Club. Charity Registration number: 1054757 Company number: 3161792 Address: 187 Freston Road, London, W10 6TH

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Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. But this will always prompt you to accept/refuse cookies when revisiting our site.

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Name*
First Name*
Last Name*
Telephone Number*
Email address*
How would you like us to keep in touch?*
If you are happy to hear from us about new and fundraising events and how your help is benefitting the young people we work with, please tick the relevant boxes.
- Telephone
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Data Protection

Harrow Club will always treat your personal details with the utmost care and will never sell or swap other organisation for their marketing purposes. We will keep your data safe, holding the information you provide for communication, marketing, analysis, and administrative purposes.

For full details of what information we hold and how we process your data please visit our privacy policy

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Harrow Club Membership Form

Step 1 of 4 - Applicant details

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Applicant details
Which club would you like to attend?*
Name of Young Person*
First Last
Address*
Street Address City Postcode
Email*
Enter Email Confirm Email
Mobile Phone*
Home Phone
Education Centre
Date of Birth*
DD slash MM slash YYYY

About you
How do you identify yourself?*
- Male
- Female
Do you have any medical conditions?*
- Yes
- No
Please list any medical conditions below.*
You can click the + icon if you need to add additional lines.
Ethnicity*
Please select which best describes you:
- Bangladeshi
- Indian
- Pakistani
- Other Asian
- Black African
- Black Caribbean
- Black British
- Other Black
- Other Mixed
- White British
- Turkish
- Moroccan
- Somali
- No Information
Disability*
Please select which best describes you:
- No Disability
- Visual Impairment
- Multiple Disabilities
- Mental Ill Health
- Moderate Learning Disability
- Severe Learning Disability
- Dyslexia
- Other
If other, please advise*

Emergency Contact
Emergency Contact*
First Last
Relationship*
Please specify*
Emergency Contact Phone Number*
Emergency Contact Email Address
Enter Email Confirm Email

Consent
Data Consent:*
Please tick to indicate you agree to us holding this data.
Harrow Club W10 uses the above data to be able to communicate with you, to ensure we are aware of any medical conditions or disabilities and to provide data to our funders. For more information on our privacy policy, please see our website – harrowclub.org
Photographic/Video Consent:*
Please tick below to indicate if you are willing for your child’s image to be used for these purposes.
From time to time, we may take photographs and/or videos of our activities and those who
participate in them in order to evidence activities and also for youth club promotional purposes.
We may wish to upload content to our website and social media platforms such as Twitter,
Facebook and Instagram. Photographs and videos will be stored on the Harrow Club network, in the Management Section which is only accessible to the Senior Management Team. Photographs will be stored for a maximum of 5 years.

Please note that, if, having given consent, you subsequently withdraw it, it may not always be possible to delete images that have already been shared or published.
Is the applicant under 18 years of age?*
- Yes
- No
Signature*
To be signed by the parent/carer if the member is under 18 years old
Pledge*
I agree to the terms listed in the membership above, and state that all the information listed is correct, to the best of my knowledge.
As a Club, we PLEDGE to provide a safe, well-equipped and welcoming club that offers positive opportunities to our members, where they can meet friends free from violence and aggression.

In return, members must agree to behave in a manner that respects other club users, the club itself and its equipment, while following our code of conduct. Members must also agree that they will not attend whilst under the influence of alcohol or any illegal substances.
Signature*
To be signed by the member if over 13 years’ old or by the parent/carer if under 13 years’ old
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Email
This field is for validation purposes and should be left unchanged.

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