GREEN STARS is an independent and voluntary Muslim youth club based in Palmers Green. As a
member of GREEN STARS, you will be able to participate in a range of supervised activities, games
and learning. There may also be outdoor activities and social events planned throughout the year.
Please provide the following information so that we can contact you. We will only contact you
about the club. We will not share your personal details with any third parties.
Member details
Full name
Gender
Address
Postcode
Date of birth
School/College/University
Email
Inspiring all young
people to fulfil their
potential and contribute
to their community,
within a framework of
Islamic life and values
Mobile phone
Languages spoken
GREEN STARS c/o MCEC
30 Oakthorpe Road,
London N13 5JL
Ethnic origin
Any illness, allergies, regular medication?
Registered charity 1043847
Any special needs or disability?
Emergency details
Please provide details of a parent/guardian that we could contact in an emergency.
Full name
Relationship
Email
tel: 020 8920 3990
greenstars@mcec.org.uk
greenstars.mcec.org.uk
/greenstarsmcec
@GreenStarsMCEC
Mobile phone
GREEN STARS is a non-profit youth club, however we kindly request a minimum contribution to
help maintain our youth projects and club facilities.
Membership costs
Full
¨
£60
annual membership fee. No session* charges apply
Per session
¨
£2
sessional fee payable at every session* attended
Family
¨
£45
annual membership per sibling. No session* charges apply
* session = ordinary, general youth club activity. Additional charges may apply for trips, courses or workshops etc.
If you are under 16, please ask your parent/guardian to sign the form before it is returned.
I agree to the above applicant being a member of GREEN STARS and participating in club activities.
For larger trips and events a separate form may be available giving you additional information.
In the event of an emergency, the club may act in my place if the need arises for the administration
of first aid and/or other medical treatment which may be necessary. I also understand that in such an
occurrence, all reasonable steps will be taken to contact me first as the relevant parent/guardian.
GREEN STARS will use pictures and videos of activities taken during clubs and outings for publicity
and/or promotional materials and on the photo gallery on the GREEN STARS website. If you do not
wish photos to be used in such a way please contact a member of the youth team and we will ensure
that such images are not used.
I acknowledge that GREEN STARS operates a banning/restriction of use policy and that the
parent/guardian may be notified in the event of bad behaviour. I understand that if the above
applicant breaks the rules, membership could be suspended or withdrawn at any time.
Print name
Date
Additional information
Signature
Membership Form
Agreement