D-Youth Hub

Cycling & Archery

Open to young people who are D/deaf, Hard of Hearing or children of Deaf adults (CODAs) between the ages of 12 and 18 years.

Location

Allestree Woodlands School, Blenheim Drive, Allestree, Derby, DE22 2LW

Day & Time
Mondays, 3:30 – 5:30pm – Please see dates below.

Dates

12th May
19th May
2nd June
9th June
16th June
23rd June
30th June

D-Youth Hub Registration

Please complete the form below to sign your child / young person up for the Derby D-Youth Hub sessions. The D-Youth Hub welcomes children / young people aged 12-18 who are d/Deaf, hard of hearing, CODAs or siblings to Deaf family members.

Child / Young Person’s Details

First Name

Middle Name

Last Name

Contact Number (optional)

Email (optional)

Address

Please list the age of the child / young person:

Please provide details of the communication needs of the child / young person:

Please provide details of any health or additional needs / support required:

Please provide any additional information we should be aware of:

Parent / Carer’s Details

Contact Number

Address

Additional Contact Name

Additional Contact Relation

Additional Contact Number

Confidentiality Policy & Data Protection Act

The personal data collected on this form will only be used for the purpose of processing the referral in accordance with our policy, i.e. for administrative reasons.

As some of the personal data we have collected is deemed sensitive under the Data Protection Act, your written consent is required. You can provide that by signing below.

I understand and agree to the processing of my personal data provided on this form according to the terms outlined above and confirm that all information on this form is correct.

Signed

Signed:

Please sign in the box:

Dated 03/05/2025

07947 714040

07528 551162