Monamee Talks: Sheneice Charway interviewed by Hamzaa -Registration for ages 14-25 years old at 6 MAY 5pm-6pm on ZOOM

Thank you for choosing to register with us. Hackney Empire will process your data in accordance with the General Data Protection Regulation (GDPR). Hackney Empire will use your information for administration, marketing and charitable purposes and with our funder's Hackney Council. Hackney Empire will not share your personal details with third parties without your consent. If you have any comments or concerns regarding the use of your data, please contact Hackney Empire.

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* 1. Personal Details

First Name *

Surname *

Date of Birth *

Borough of London(if applicable) *

City/Town

Postal Code *

Instagram Handle (if applicable) *

Email Address *

Phone Number *

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* 2. We collect ethnicity and gender information to monitor equality and diversity. This information is given to our funders Hackney Council. If you are happy to share this information please write below.

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* 3. Gender

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* 4. Education (where applicable)

Name of Place of Study

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* 5. Please tell us a bit about yourself and why you would like to be part of this session?

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* 6. Any questions you would like to submit in advance?

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* 7.
Guardian/Parent/ Carer for Emergency Contact Details-
We ask for these contact details in case of an emergency and to contact your guardian for consent if under 18.

Primary Contact-Full Name *

Relationship to applicant *

Email Address

Phone Number

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* 8. Do you have any access requirements, medical conditions, disabilities you would like us to know about?

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* 9. PERSONAL/PARENT/GUARDIAN CONSENT: Workshops are for young people aged 14-25 y/o. As this is a Zoom workshop we request your consent to have your video on and for the session to be recorded. Please confirm you are happy to consent below
UNDER 18'S-We will require consent from your parent/guardian for photography and filming. By ticking this box you agree that you have consent and are happy for us to email your emergency contact to confirm this consent. If you have any questions please email projects@hackneyempire.co.uk

Yes -please provide date

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* 10. How did you find out about us?

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* 11. Would you like to hear about future Creative Futures Opportunities at Hackney Empire?

Yes- I am happy to be contacted by Hackney Empire about further opportunities by email

Yes- I am happy to be contacted by Hackney Empire about further opportunities by Instagram

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* 1. Personal Details

Question Title

* 2. We collect ethnicity and gender information to monitor equality and diversity. This information is given to our funders Hackney Council. If you are happy to share this information please write below.

Question Title

* 3. Gender

Question Title

* 4. Education (where applicable)

Question Title

* 5. Please tell us a bit about yourself and why you would like to be part of this session?

Question Title

* 6. Any questions you would like to submit in advance?

Question Title

* 7. Guardian/Parent/ Carer for Emergency Contact Details- We ask for these contact details in case of an emergency and to contact your guardian for consent if under 18.

Question Title

* 8. Do you have any access requirements, medical conditions, disabilities you would like us to know about?

Question Title

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* 10. How did you find out about us?

Question Title

* 11. Would you like to hear about future Creative Futures Opportunities at Hackney Empire?

* 7.
Guardian/Parent/ Carer for Emergency Contact Details-
We ask for these contact details in case of an emergency and to contact your guardian for consent if under 18.